Provider Demographics
NPI:1659741957
Name:LOCKE, LOU RANDALL (FNP)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:RANDALL
Last Name:LOCKE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-1812
Mailing Address - Country:US
Mailing Address - Phone:409-882-4705
Mailing Address - Fax:409-886-5305
Practice Address - Street 1:3838 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-1812
Practice Address - Country:US
Practice Address - Phone:409-882-4705
Practice Address - Fax:409-886-5305
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily