Provider Demographics
NPI:1225111826
Name:LOCKWOOD, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 S DIXON RD
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-6411
Mailing Address - Country:US
Mailing Address - Phone:765-455-5400
Mailing Address - Fax:765-865-3912
Practice Address - Street 1:2330 S DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-6400
Practice Address - Country:US
Practice Address - Phone:765-455-5400
Practice Address - Fax:765-865-3912
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100136340Medicaid
080159416Medicare PIN
IN151560K4Medicare PIN
IN100136340Medicaid
080159416Medicare PIN