Provider Demographics
NPI:1174521660
Name:LOCKHART, REBECCA JANE (ARNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JANE
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 42
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-894-9499
Practice Address - Fax:502-894-9595
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2015-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3004432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200507950Medicaid
KYPENDINGMedicaid
KYQ33740Medicare UPIN
IN200507950Medicaid