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General NPI Number Information
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NPI Number | 1396156188
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Entity Type | Individual
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Provider Name | KAHLEEL LOCKE
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Gender | Female
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 70 LAFAYETTES LNDG
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City | JONESBORO
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State | GA
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Zip | 30238-6702
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Country | US
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Telephone | 646-752-8144
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 HIGHWAY 85 N STE 310-379
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7738
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Country | US
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Telephone | 646-752-8144
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 754102
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 407106
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP297748
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN297748
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License Number State | GA
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