=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316800964
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KINSEY LOCKARD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2025
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 PROSPECT ST
-----------------------------------------------------
City | EAST STROUDSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18301-2956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-422-3211
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3072 HUTCHINSON RIVER RD
-----------------------------------------------------
City | PHILLIPSBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08865-9341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-763-2410
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------