Provider Demographics
NPI:1801321146
Name:LOCKWOOD, KELLEY LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:LYNN
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 STONEWALL PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-9351
Mailing Address - Country:US
Mailing Address - Phone:318-218-9049
Mailing Address - Fax:
Practice Address - Street 1:901 STONEWALL PRESTON RD
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-9351
Practice Address - Country:US
Practice Address - Phone:318-218-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA144664163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care