Healthcare Provider Details

I. General information

NPI: 1467989350
Provider Name (Legal Business Name): MELISSA ELIZABETH LOCKHART CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEMORIAL DR
JACKSONVILLE NC
28546-6328
US

IV. Provider business mailing address

PO BOX 986513 DEPT 100
BOSTON MA
02298-6513
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-0581
  • Fax: 910-353-1351
Mailing address:
  • Phone: 910-219-8326
  • Fax: 910-939-4269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP95005765
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5017249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: