Provider Demographics
NPI:1386027225
Name:LOCKHART, JESSICA ELAINE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELAINE
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 DOGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-2424
Mailing Address - Country:US
Mailing Address - Phone:804-556-4418
Mailing Address - Fax:
Practice Address - Street 1:2715 DOGTOWN RD
Practice Address - Street 2:
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-2424
Practice Address - Country:US
Practice Address - Phone:804-556-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program