Healthcare Provider Details

I. General information

NPI: 1164595252
Provider Name (Legal Business Name): MARY JANE LOCKHART RN, MS, CPNP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 DARNALL LOOP CARL R DARNALL ARMY MEDICAL CENTER
FORT HOOD TX
76544-4752
US

IV. Provider business mailing address

1402 CARDINAL TRL
COPPERAS COVE TX
76522-1950
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8440
  • Fax:
Mailing address:
  • Phone: 254-547-1305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number574376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: