Provider Demographics
NPI:1639307432
Name:LOCKARD, MARY R (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY JEAN
Other - Middle Name:
Other - Last Name:LOCKARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:16260 VENTURA BLVD STE 630
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2255
Mailing Address - Country:US
Mailing Address - Phone:747-264-9201
Mailing Address - Fax:818-337-7494
Practice Address - Street 1:16260 VENTURA BLVD STE 630
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2255
Practice Address - Country:US
Practice Address - Phone:747-264-9201
Practice Address - Fax:818-337-7494
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18984363LF0000X
CA18984363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily