Healthcare Provider Details

I. General information

NPI: 1215923529
Provider Name (Legal Business Name): MELANIE M. LOCKWOOD WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 SW H K DODGEN LOOP
TEMPLE TX
76502-1836
US

IV. Provider business mailing address

1905 SW H K DODGEN LOOP
TEMPLE TX
76502-1814
US

V. Phone/Fax

Practice location:
  • Phone: 254-298-2682
  • Fax: 254-778-7197
Mailing address:
  • Phone: 254-298-2682
  • Fax: 254-778-7197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number230676
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: