Provider Demographics
NPI:1003647124
Name:LOCKETT, CRYSTAL MECHELLE (APRN)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MECHELLE
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 HIGHWAY 32 N
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8807
Mailing Address - Country:US
Mailing Address - Phone:870-826-3792
Mailing Address - Fax:
Practice Address - Street 1:3140 HIGHWAY 32 N
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8807
Practice Address - Country:US
Practice Address - Phone:870-826-3792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR224753363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health