# LOCKE AESTHETICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497993547
- **Authorized official:** DR. KELLY LOCKE MD (OWNER)
- **Authorized official phone:** (970) 279-4111

## Contact information

- **Practice address:** 1450 E VALLEY RD, SUITE 101, BASALT, CO 81621-8304
- **Practice address phone:** (970) 279-4111
- **Practice address fax:** (970) 927-3915
- **Mailing address:** 1450 E VALLEY RD, SUITE 101, BASALT, CO 81621-8304
- **Mailing address phone:** (970) 279-4111
- **Mailing address fax:** (970) 927-3915

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 38023 | CO | Yes |

## Other

- **Enumeration date:** 01/28/2009
- **Last updated:** 01/28/2009