Provider Demographics
NPI:1295032704
Name:LOCKE, KEN SHELTON (PA)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:SHELTON
Last Name:LOCKE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:7940 FLOYD CURL
Mailing Address - Street 2:STE 630
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3905
Mailing Address - Country:US
Mailing Address - Phone:210-614-1112
Mailing Address - Fax:210-614-1113
Practice Address - Street 1:7940 FLOYD CURL
Practice Address - Street 2:STE 630
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3905
Practice Address - Country:US
Practice Address - Phone:210-614-1112
Practice Address - Fax:210-614-1113
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
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Provider Licenses
StateLicense IDTaxonomies
TXPA01080363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical