Provider Demographics
NPI:1679080568
Name:LOCKHART, CATRINA DESHAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CATRINA
Middle Name:DESHAN
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-6216
Mailing Address - Country:US
Mailing Address - Phone:601-517-6432
Mailing Address - Fax:
Practice Address - Street 1:472 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-6216
Practice Address - Country:US
Practice Address - Phone:601-517-6432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR882952163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical