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General NPI Number Information
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NPI Number | 1962073080
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Entity Type | Individual
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Provider Name | KHELLI AMEKE LOCKRIDGE DNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 102 PECAN BLVD
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City | VICKSBURG
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State | MS
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Zip | 39183-8766
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Country | US
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Telephone | 601-985-8029
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 MISSION 66 STE C
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City | VICKSBURG
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State | MS
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Zip | 39180-3762
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Country | US
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Telephone | 601-714-1404
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 904688
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License Number State | MS
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