Provider Demographics
NPI:1962073080
Name:LOCKRIDGE, KHELLI AMEKE (DNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KHELLI
Middle Name:AMEKE
Last Name:LOCKRIDGE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 MISSION 66 STE C
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3762
Mailing Address - Country:US
Mailing Address - Phone:601-714-1404
Mailing Address - Fax:
Practice Address - Street 1:102 PECAN BLVD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-8766
Practice Address - Country:US
Practice Address - Phone:601-985-8029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily