Provider Demographics
NPI:1154360279
Name:LOCKETT, LAURA BEASLEY (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BEASLEY
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-1181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:923 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2768
Practice Address - Country:US
Practice Address - Phone:423-907-1200
Practice Address - Fax:865-291-3228
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8105363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00295811OtherMEDICARE RAILROAD
KY78015559Medicaid
TN4057237OtherBCBS
KY78015559Medicaid
TNP00295811OtherMEDICARE RAILROAD