MEDICARE: REESHEMAH KMYATTA LOCKHART CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	008617	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497262315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REESHEMAH KMYATTA LOCKHART CNA

Provider Business Mailing Address
First Line	:	1223 MAXINE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-4413
Country	:	US
Telephone Number	:	832-290-2981
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 MAXINE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77029-4413
Country	:	US
Telephone Number	:	832-290-2981
Fax Number	:	832-290-2981

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2017
Last Update Date	:	12/30/2017

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