Provider Demographics
NPI:1770649980
Name:LOCKHART, EMERALD L
Entity Type:Individual
Prefix:
First Name:EMERALD
Middle Name:L
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 CORDOVA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-7273
Mailing Address - Country:US
Mailing Address - Phone:907-644-6050
Mailing Address - Fax:907-644-4438
Practice Address - Street 1:4450 CORDOVA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7273
Practice Address - Country:US
Practice Address - Phone:907-644-6050
Practice Address - Fax:907-644-4438
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM2802Medicaid