Provider Demographics
NPI:1972140507
Name:LOCKETT, RALSTON (NP - C)
Entity type:Individual
Prefix:
First Name:RALSTON
Middle Name:
Last Name:LOCKETT
Suffix:
Gender:M
Credentials:NP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 FANNIN ST APT 328
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-4670
Mailing Address - Country:US
Mailing Address - Phone:832-549-7838
Mailing Address - Fax:
Practice Address - Street 1:10000 FANNIN ST APT 328
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-4670
Practice Address - Country:US
Practice Address - Phone:832-549-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily