Provider Demographics
NPI:1700867603
Name:LOCKART, KIM ANNE (WHNP)
Entity Type:Individual
Prefix:
First Name:KIM ANNE
Middle Name:
Last Name:LOCKART
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-0600
Mailing Address - Country:US
Mailing Address - Phone:928-213-6100
Mailing Address - Fax:928-522-9664
Practice Address - Street 1:2920 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1816
Practice Address - Country:US
Practice Address - Phone:928-221-3610
Practice Address - Fax:928-213-6125
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN037758163W00000X
AZAP0336363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse