Provider Demographics
NPI:1356410443
Name:LOCKETT, RICKY P (DO)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:P
Last Name:LOCKETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2788
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-2788
Mailing Address - Country:US
Mailing Address - Phone:727-896-8686
Mailing Address - Fax:727-317-2716
Practice Address - Street 1:5800 49TH ST N STE S-207
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2146
Practice Address - Country:US
Practice Address - Phone:727-896-8686
Practice Address - Fax:727-317-2716
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59-3207217174400000X
FLOS61092081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL596170300Medicaid
FL80494OtherBC/BS PROVIDER ID
FLOS 6109OtherLICENSE NUMBER
FLE91853Medicare UPIN
FL596170300Medicaid