Healthcare Provider Details

I. General information

NPI: 1225947583
Provider Name (Legal Business Name): ABAGAIL LOCKHART PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11745 US HIGHWAY 23 S
OSSINEKE MI
49766-9582
US

IV. Provider business mailing address

509 S 2ND AVE
ALPENA MI
49707-3823
US

V. Phone/Fax

Practice location:
  • Phone: 989-471-2156
  • Fax:
Mailing address:
  • Phone: 989-657-5141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014241
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: