Healthcare Provider Details

I. General information

NPI: 1598149296
Provider Name (Legal Business Name): ERIC THOMAS LOCKETT ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9229 WARD PKWY STE 380
KANSAS CITY MO
64114-5471
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8072
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 816-319-4785
  • Fax:
Mailing address:
  • Phone: 314-362-9123
  • Fax: 314-747-4876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2018008251
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: