Provider Demographics
NPI:1992786032
Name:LOCKHART, CINDY B (NP)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:B
Last Name:LOCKHART
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:264 POOR HOUSE RD E
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-5812
Mailing Address - Country:US
Mailing Address - Phone:662-462-8018
Mailing Address - Fax:
Practice Address - Street 1:360 HARDY RD
Practice Address - Street 2:
Practice Address - City:MISSISSIPPI STATE
Practice Address - State:MS
Practice Address - Zip Code:39752
Practice Address - Country:US
Practice Address - Phone:662-325-1614
Practice Address - Fax:662-325-8888
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05282216Medicaid
MS05282216Medicaid