Provider Demographics
NPI:1801696281
Name:LOCKETT, DAISHA
Entity type:Individual
Prefix:
First Name:DAISHA
Middle Name:
Last Name:LOCKETT
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 1:4009 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-2848
Mailing Address - Country:US
Mailing Address - Phone:757-202-7393
Mailing Address - Fax:757-202-7393
Practice Address - Street 1:4009 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-2848
Practice Address - Country:US
Practice Address - Phone:757-202-7393
Practice Address - Fax:757-202-7393
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-15
Last Update Date:2025-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist