Provider Demographics
NPI:1871192195
Name:LOCKART, KELSEY TAYLOR
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:TAYLOR
Last Name:LOCKART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:TAYLOR
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3601 RICHARDS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2954
Mailing Address - Country:US
Mailing Address - Phone:501-221-1843
Mailing Address - Fax:
Practice Address - Street 1:3601 RICHARDS RD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2954
Practice Address - Country:US
Practice Address - Phone:501-221-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR252939795Medicaid