Basic Information
| Provider Information | |||||||||
| NPI: | 1811343148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOCKARD | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | ASHLEY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | A-GNP-C, RDN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HARRIS | ||||||||
| OtherFirstName: | CARMEN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 415 W GOLF RD STE 26 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600053923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557008184 | ||||||||
| FaxNumber: | 2246331935 | ||||||||
| Practice Location | |||||||||
| Address1: | 1927 MEMORIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371291545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159002038 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2016 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | 2817 | TN | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | 133V00000X | 2817 | TN | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 363L00000X | 32630 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.