=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932065695
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICKAYLA MAESY LOCKE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2025
-----------------------------------------------------
Last Update Date | 12/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 SCOTT AND WHITE DR
-----------------------------------------------------
City | COLLEGE STATION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77845-6419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-207-3300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6002 FM 2445 RD
-----------------------------------------------------
City | NAVASOTA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77868-7510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-450-6299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------