Provider Demographics
NPI:1811343148
Name:LOCKARD, CARMEN ASHLEY (A-GNP-C)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:ASHLEY
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4255
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:
Practice Address - Street 1:1287 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-3333
Practice Address - Country:US
Practice Address - Phone:615-794-8217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2817133NN1002X, 133V00000X
TN32630363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered