Healthcare Provider Details

I. General information

NPI: 1558177790
Provider Name (Legal Business Name): ALEXANDRIA DANIELLE LOCKE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 S EASON BLVD
TUPELO MS
38801-6540
US

IV. Provider business mailing address

30 SHADY CV
BELMONT MS
38827-8773
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-3000
  • Fax:
Mailing address:
  • Phone: 662-279-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number918585
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: