Provider Demographics
NPI:1477295723
Name:LOCKHART, MELISSA D
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
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 1:244 POCAHONTAS AVE
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1785
Mailing Address - Country:US
Mailing Address - Phone:304-647-5285
Mailing Address - Fax:
Practice Address - Street 1:244 POCAHONTAS AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1785
Practice Address - Country:US
Practice Address - Phone:304-647-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant