Provider Demographics
NPI:1568417673
Name:LOCKETT, KERRY L (MD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:L
Last Name:LOCKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RISING STAR
Mailing Address - State:TX
Mailing Address - Zip Code:76471-5205
Mailing Address - Country:US
Mailing Address - Phone:830-422-1535
Mailing Address - Fax:
Practice Address - Street 1:608 AVENUE B
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-2406
Practice Address - Country:US
Practice Address - Phone:325-365-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9745207P00000X, 207Q00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24432Medicare UPIN