Provider Demographics
NPI:1750087508
Name:LOCKHART, KATELYN FAITH
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:FAITH
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:FAITH
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:695 MOUNTAINEER HWY
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0255
Mailing Address - Country:US
Mailing Address - Phone:304-294-8800
Mailing Address - Fax:
Practice Address - Street 1:695 MOUNTAINEER HWY
Practice Address - Street 2:
Practice Address - City:MULLENS
Practice Address - State:WV
Practice Address - Zip Code:25882-0255
Practice Address - Country:US
Practice Address - Phone:304-294-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant