Healthcare Provider Details

I. General information

NPI: 1639307432
Provider Name (Legal Business Name): MARY R LOCKARD N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY JEAN LOCKARD N.P.

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 02/22/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE 630
ENCINO CA
91436-2255
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 747-264-9201
  • Fax: 818-337-7494
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP18984
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: