Provider Demographics
NPI:1972543072
Name:LOCKE, DESTINY H (NP)
Entity Type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:H
Last Name:LOCKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HEALTH WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2658
Mailing Address - Country:US
Mailing Address - Phone:931-473-4214
Mailing Address - Fax:931-473-0666
Practice Address - Street 1:155 HEALTH WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2658
Practice Address - Country:US
Practice Address - Phone:931-473-4214
Practice Address - Fax:931-473-0666
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3904079Medicaid
TN3732438Medicaid
4167862OtherBCBST
TN3719062Medicaid
3732438Medicare PIN
TNP34989Medicare UPIN
TN3732438Medicaid
TN3719062Medicaid