=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437808490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON JANE LOCKE FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2022
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2044 NY-32
-----------------------------------------------------
City | MODENA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 854-883-5176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 250 OVERLOOK RD
-----------------------------------------------------
City | POUGHKEEPSIE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12603-6238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-742-1648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 355703
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1053472
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------