Provider Demographics
NPI:1629883491
Name:LOCKHART, KHADIJAH EBONI
Entity type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:EBONI
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 N 92ND AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-5957
Mailing Address - Country:US
Mailing Address - Phone:402-637-9992
Mailing Address - Fax:
Practice Address - Street 1:9830 ELLISON AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1618
Practice Address - Country:US
Practice Address - Phone:402-637-9992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant