Provider Demographics
NPI:1609243682
Name:LOCKRIDGE, LYNETTE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:LOCKRIDGE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:LYNETTE
Other - Middle Name:
Other - Last Name:WINDOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:P.O. BOX 284
Mailing Address - Street 2:
Mailing Address - City:EGYPT
Mailing Address - State:TX
Mailing Address - Zip Code:77436-0284
Mailing Address - Country:US
Mailing Address - Phone:832-279-9818
Mailing Address - Fax:
Practice Address - Street 1:439 WILLIE LOU
Practice Address - Street 2:
Practice Address - City:EGYPT
Practice Address - State:TX
Practice Address - Zip Code:77436
Practice Address - Country:US
Practice Address - Phone:832-279-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX621054163W00000X
3104A0625X, 3104A0630X, 251C00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No163W00000XNursing Service ProvidersRegistered Nurse
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care