Healthcare Provider Details

I. General information

NPI: 1881199495
Provider Name (Legal Business Name): KAITLIN CLAIRE LOCKHART AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

IV. Provider business mailing address

450 BROOKLINE AVE
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-4500
  • Fax: 617-632-5370
Mailing address:
  • Phone: 617-632-4500
  • Fax: 617-632-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN1048125
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2372186
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR210006
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: