Individual provider Active NPI

Kathy McKnight Lockett, NNP

  • Neonatal Nurse Practitioner
  • Austell, GA
National Provider Identifier
1225036015
Registry record updated Nov 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
RN114267 Issued in GA
Practice address
1790 Mulkey Rd
Austell, GA 30106-1122
Phone
(404) 277-0916
Fax
(770) 943-9106
NPI assigned
Jul 14, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X RN114267 GA Primary

Addresses

Primary practice location

1790 Mulkey Rd
Austell, GA 30106-1122

Mailing address

3750 Cliff Crest Dr SE
Smyrna, GA 30080-5877
Phone (404) 277-0916

Other practice location 1

5901C Peachtree Dunwoody Rd NE
Suite C-65
Atlanta, GA 30328-5382
Phone (404) 252-9751

Other identifiers 3

IdentifierTypeStateIssuer
00936218DMedicaidGA
00936218BMedicaidGA
00936218EMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN114267GAMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Neonatology Associates of Atlanta, P.C. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542240000000",
    "number": "1225036015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3750 CLIFF CREST DR SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300805877",
            "telephone_number": "404-277-0916",
            "fax_number": "770-943-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 MULKEY RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061122",
            "telephone_number": "404-277-0916",
            "fax_number": "770-943-9106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5901C Peachtree Dunwoody Rd NE",
            "address_2": "Suite C-65",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303285382",
            "country_code": "US",
            "telephone_number": "404-252-9751",
            "fax_number": "678-990-5763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOCKETT",
        "first_name": "KATHY",
        "middle_name": "MCKNIGHT",
        "name_prefix": "Ms.",
        "credential": "NNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-14",
        "last_updated": "2018-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "GA",
            "license": "RN114267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00936218D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00936218B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00936218E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.