Provider Demographics
NPI:1235536350
Name:LOCKETT, NAOMI (FNP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17855 DALLAS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6857
Mailing Address - Country:US
Mailing Address - Phone:909-295-6006
Mailing Address - Fax:909-331-4801
Practice Address - Street 1:6400 SHAFER CT STE 300
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-4929
Practice Address - Country:US
Practice Address - Phone:847-759-9449
Practice Address - Fax:847-759-9448
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-04
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012080363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily