Provider Demographics
NPI:1710546122
Name:LOCKMILLER, KRISTEN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:LOCKMILLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-3354
Mailing Address - Country:US
Mailing Address - Phone:256-609-1813
Mailing Address - Fax:
Practice Address - Street 1:406 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2403
Practice Address - Country:US
Practice Address - Phone:256-574-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily