Healthcare Provider Details

I. General information

NPI: 1285213710
Provider Name (Legal Business Name): ELIZABETH HALE LOCKETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S CREASY LN STE 200
LAFAYETTE IN
47905-7434
US

IV. Provider business mailing address

1411 S CREASY LN STE 200
LAFAYETTE IN
47905-7434
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-5000
  • Fax:
Mailing address:
  • Phone: 765-446-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.45373
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01100433A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: