Healthcare Provider Details

I. General information

NPI: 1568417673
Provider Name (Legal Business Name): KERRY L LOCKETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 AVENUE B
BALLINGER TX
76821-2406
US

IV. Provider business mailing address

517 S MAIN ST
RISING STAR TX
76471-5205
US

V. Phone/Fax

Practice location:
  • Phone: 325-365-2531
  • Fax:
Mailing address:
  • Phone: 830-422-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberF9745
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF9745
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberF9745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: