Provider Demographics
NPI:1356197776
Name:LOCKHART, MANDY (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14949 N US HIGHWAY 25 E STE 3
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-6285
Mailing Address - Country:US
Mailing Address - Phone:606-280-4212
Mailing Address - Fax:
Practice Address - Street 1:14949 N US HIGHWAY 25 E STE 3
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6285
Practice Address - Country:US
Practice Address - Phone:606-280-4212
Practice Address - Fax:606-215-3816
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4023854363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health