Healthcare Provider Details

I. General information

NPI: 1124309620
Provider Name (Legal Business Name): BRITTANY R LOCKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 W MONROE ST
KOKOMO IN
46901-3257
US

IV. Provider business mailing address

915 W MONROE ST
KOKOMO IN
46901-3257
US

V. Phone/Fax

Practice location:
  • Phone: 765-431-4180
  • Fax:
Mailing address:
  • Phone: 765-431-4180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1003031
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number0902800
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: