Healthcare Provider Details

I. General information

NPI: 1578485470
Provider Name (Legal Business Name): ERIN MCKENZIE LOCKE MSN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N KEENE ST STE 404
COLUMBIA MO
65201-8054
US

IV. Provider business mailing address

970 N HICKMAN ST
CENTRALIA MO
65240-1300
US

V. Phone/Fax

Practice location:
  • Phone: 573-777-7627
  • Fax:
Mailing address:
  • Phone: 660-654-4117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2026036417
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: