Healthcare Provider Details

I. General information

NPI: 1104852854
Provider Name (Legal Business Name): LAURA JANE LOCKHART CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 W KING ST
KINGS MOUNTAIN NC
28086-2708
US

IV. Provider business mailing address

12412 DARBY CHASE DR
CHARLOTTE NC
28277-3200
US

V. Phone/Fax

Practice location:
  • Phone: 704-730-5405
  • Fax: 704-730-5399
Mailing address:
  • Phone: 704-846-9613
  • Fax: 704-846-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number036534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: