Provider Demographics
NPI:1346393451
Name:LOCKETT, NANCY C (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3045
Mailing Address - Country:US
Mailing Address - Phone:206-242-7822
Mailing Address - Fax:206-244-2133
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:SUITE 230
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-242-7822
Practice Address - Fax:206-244-2133
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00075156208000000X
WAAP30000801363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9627357Medicaid
WAGAB14589Medicare PIN
WA9627357Medicaid
WAGAB14586Medicare PIN
WAGAB14587Medicare PIN
WAGAB14585Medicare PIN
WAP02707Medicare UPIN