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NPI Code Detail

MEDICARE: LEANNA LOCKETT

MEDICARE: LEANNA LOCKETT
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
1207Q00000XFamily Medicine PhysicianOP61493787WA

General Provider Information

NPI Number : 1639709884
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANNA LOCKETT
Provider Business Mailing Address
First Line : 3007 BORST AVE APT B6
Second Line :
City : CENTRALIA
State : WA
Zip : 98531-2244
Country : US
Telephone Number : 360-909-4356
Fax Number :
Provider Business Practice Location Address
First Line : 111 UNIVERSITY PKWY STE 202
Second Line :
City : YAKIMA
State : WA
Zip : 98901-1448
Country : US
Telephone Number : 509-452-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2020
Last Update Date : 07/02/2024

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Directions to “ LEANNA LOCKETT ” Practice Location

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