Provider Demographics
NPI:1275904625
Name:LOCK, EVA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:LOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2863 PARKER DR
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-6708
Mailing Address - Country:US
Mailing Address - Phone:618-638-5750
Mailing Address - Fax:
Practice Address - Street 1:2670 NEW HOLT RD STE C
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7506
Practice Address - Country:US
Practice Address - Phone:270-575-1010
Practice Address - Fax:270-575-1018
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily