Provider Demographics
NPI:1376620096
Name:LOCKHART, MELISSA C (PHD, GNP BC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:C
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:PHD, GNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 BARKER CYPRESS RD
Mailing Address - Street 2:STE 1500
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1223
Mailing Address - Country:US
Mailing Address - Phone:281-500-8600
Mailing Address - Fax:281-500-9699
Practice Address - Street 1:8190 BARKER CYPRESS RD
Practice Address - Street 2:STE 1500
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1223
Practice Address - Country:US
Practice Address - Phone:281-500-8600
Practice Address - Fax:281-500-9699
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-25518363L00000X
TXAP111268363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321777YMN0OtherIND PTAN
TX2035487-02OtherGROUP TPI
TXTXB102731OtherMEDICARE GROUP