Provider Demographics
NPI:1598714065
Name:LOCKETT, FREDERICKA CREECH (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICKA
Middle Name:CREECH
Last Name:LOCKETT
Suffix:
Gender:F
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40008
Mailing Address - Country:US
Mailing Address - Phone:502-252-5081
Mailing Address - Fax:502-252-7211
Practice Address - Street 1:107 PERRY ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:KY
Practice Address - Zip Code:40008
Practice Address - Country:US
Practice Address - Phone:502-252-5081
Practice Address - Fax:502-252-7211
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000047086OtherANTHEM
610963741BOtherHUMANA
080025519OtherRAILROAD MEDICARE
243244900OtherPASSPORT
1049285OtherPASSPORT
KY64198930Medicaid
610963741BOtherHUMANA
1049285OtherPASSPORT
D92415Medicare UPIN