Provider Demographics
NPI:1215554183
Name:PERRY-LOCKARD, KATIE JOANN
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:JOANN
Last Name:PERRY-LOCKARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1796
Mailing Address - Country:US
Mailing Address - Phone:304-872-2090
Mailing Address - Fax:
Practice Address - Street 1:804 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1796
Practice Address - Country:US
Practice Address - Phone:304-872-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant