Basic Information
| Provider Information | |||||||||
| NPI: | 1346393451 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOCKETT | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16233 SYLVESTER RD SW | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062427822 | ||||||||
| FaxNumber: | 2062442133 | ||||||||
| Practice Location | |||||||||
| Address1: | 16233 SYLVESTER RD SW | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062427822 | ||||||||
| FaxNumber: | 2062442133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 01/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | RN00075156 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics | 363L00000X | AP30000801 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 9627357 | 05 | WA | MEDICAID |