MEDICARE: MR. SHAWN TERRENCE LOCKETT PA

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	363A00000X	Physician Assistant		WA

General Provider Information

NPI Number	:	1932198439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN TERRENCE LOCKETT PA

Provider Business Mailing Address
First Line	:	CMR 420 BOX 2452
Second Line	:
City	:	APO
State	:	AE
Zip	:	09063
Country	:	US
Telephone Number	:	971-645-4334
Fax Number	:

Provider Business Practice Location Address
First Line	:	HHC 18TH MEDCOM BOX 592 UNIT 15281
Second Line	:
City	:	APO
State	:	AP
Zip	:	96205-0054
Country	:	US
Telephone Number	:	971-645-4334
Fax Number	:

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/21/2022

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Directions to “ MR. SHAWN TERRENCE LOCKETT PA” Practice Location

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