Basic Information
Provider Information
NPI: 1861666026
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOCKE
FirstName: JUDY
MiddleName: BARRETT
NamePrefix:  
NameSuffix:  
Credential: MS, RN, APRN-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BARRETT
OtherFirstName: JUDY
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: RN
OtherLastNameType: 1
Mailing Information
Address1: 650 E INDIAN SCHOOL RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850121839
CountryCode: US
TelephoneNumber: 6022775551
FaxNumber: 6022226563
Practice Location
Address1: 650 E INDIAN SCHOOL RD
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850121839
CountryCode: US
TelephoneNumber: 6022775551
FaxNumber: 6022226563
Other Information
ProviderEnumerationDate: 04/18/2008
LastUpdateDate: 04/18/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
364SC1501XRN032102AZY Physician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health

No ID Information.


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