Provider Demographics
NPI:1629335609
Name:LOCKETT, RENEE D (NP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:D
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 631671
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1671
Mailing Address - Country:US
Mailing Address - Phone:877-227-8823
Mailing Address - Fax:313-578-6393
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7339
Practice Address - Fax:269-341-7781
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704237985363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704237985OtherMI LICENSE