Healthcare Provider Details

I. General information

NPI: 1992786032
Provider Name (Legal Business Name): CINDY B LOCKHART NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 HARDY RD
MISSISSIPPI STATE MS
39752
US

IV. Provider business mailing address

264 POOR HOUSE RD E
STARKVILLE MS
39759-5812
US

V. Phone/Fax

Practice location:
  • Phone: 662-325-1614
  • Fax: 662-325-8888
Mailing address:
  • Phone: 662-462-8018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR851841
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: