Provider Demographics
NPI:1386146785
Name:LOCKWOOD, KAWANA SHANTA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:KAWANA
Middle Name:SHANTA
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KAWANA
Other - Middle Name:SHANTA
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:157 E LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2411
Mailing Address - Country:US
Mailing Address - Phone:601-278-9688
Mailing Address - Fax:
Practice Address - Street 1:106 BUSINESS PARK AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726
Practice Address - Country:US
Practice Address - Phone:888-417-5250
Practice Address - Fax:225-341-8756
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09852363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner