Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN114267 | GA |
NPI | 1225036015 |
---|---|
Provider Name | Ms. Kathy Mcknight Lockett |
First Address | Smyrna, GA 30080-5877 |
Second Address | Austell, GA 30106-1122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 15/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00936218B | (05) | GA |
00936218D | (05) | GA |
00936218E | (05) | GA |