Provider Demographics
NPI:1497102818
Name:LOCKHART, JENNIFER LYNN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-9285
Mailing Address - Country:US
Mailing Address - Phone:304-482-5146
Mailing Address - Fax:
Practice Address - Street 1:3612 POWHATAN RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-9217
Practice Address - Country:US
Practice Address - Phone:919-550-2200
Practice Address - Fax:919-359-2529
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV72510163W00000X
OHRN.408791-1163W00000X
NC309908163W00000X
NC5011263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse