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General NPI Number Information
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NPI Number | 1154360279
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Entity Type | Individual
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Provider Name | LAURA BEASLEY LOCKETT FNP
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Gender | Female
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 923 E CENTRAL AVE
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City | LA FOLLETTE
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State | TN
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Zip | 37766-2768
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Country | US
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Telephone | 423-907-1200
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Fax | 865-291-3228
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Provider Business Mailing Address
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Address Line | 304 WRIGHT ST
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City | SWEETWATER
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State | TN
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Zip | 37874-1181
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 8105
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License Number State | TN
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