Provider Demographics
NPI:1659731313
Name:LOCKHART, ROBIN ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ANN
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:ANN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:7212 GOLDVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801
Mailing Address - Country:US
Mailing Address - Phone:716-378-5562
Mailing Address - Fax:706-722-7235
Practice Address - Street 1:1120 15TH ST BA-9413
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-2861
Practice Address - Fax:706-721-7136
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219964363L00000X
SC19999363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN219964OtherLICENSE
SCNP3890Medicaid