Provider Demographics
NPI:1467257253
Name:LOCK, KACEY DAYLE (RN)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:DAYLE
Last Name:LOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 N INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47977-8791
Mailing Address - Country:US
Mailing Address - Phone:219-863-1416
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:219-863-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28284842A163W00000X
IN28284842C163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse