Provider Demographics
NPI:1497262315
Name:LOCKHART, REESHEMAH KMYATTA (CNA)
Entity Type:Individual
Prefix:
First Name:REESHEMAH
Middle Name:KMYATTA
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 MAXINE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77029-4413
Mailing Address - Country:US
Mailing Address - Phone:832-290-2981
Mailing Address - Fax:
Practice Address - Street 1:1223 MAXINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-4413
Practice Address - Country:US
Practice Address - Phone:832-290-2981
Practice Address - Fax:832-290-2981
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-30
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008617251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1033115704Medicaid