Provider Demographics
NPI:1790107258
Name:LOCK, ALICIA KINTON (NP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KINTON
Last Name:LOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ELIZABETH
Other - Last Name:KINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:200 BOYLSTON ST FL 4
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2008
Mailing Address - Country:US
Mailing Address - Phone:617-278-8660
Mailing Address - Fax:617-278-8670
Practice Address - Street 1:200 BOYLSTON ST FL 4
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2008
Practice Address - Country:US
Practice Address - Phone:617-278-8660
Practice Address - Fax:617-754-0210
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX848575363LW0102X
MARN2288353363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health