| NPI | 1215568175 |
|---|---|
| Former Name | MIKAYLA K LOCKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 2429) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 115612) |
| 363AM0700X Physician Assistant, Medical (Licence: NE 2429) | |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2023-05-13 |