Healthcare Provider Details

I. General information

NPI: 1023306206
Provider Name (Legal Business Name): RICKY P. LOCKETT, D.O, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 49TH ST N STE S-207
ST PETERSBURG FL
33709-2146
US

IV. Provider business mailing address

1012 DRUID RD E
CLEARWATER FL
33756-5606
US

V. Phone/Fax

Practice location:
  • Phone: 727-896-8686
  • Fax: 727-317-2716
Mailing address:
  • Phone: 727-896-8686
  • Fax: 727-441-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS6109
License Number StateFL

VIII. Authorized Official

Name: MR. RICKY P LOCKETT
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 727-896-8686