Provider Demographics
NPI:1639973167
Name:LOCK, PAYTON
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:LOCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 IRONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PACKWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:52580-8507
Mailing Address - Country:US
Mailing Address - Phone:641-919-7194
Mailing Address - Fax:
Practice Address - Street 1:14701 N SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3411
Practice Address - Country:US
Practice Address - Phone:405-752-2733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program