Individual
JONYA LOCKART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 351-4878
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209014547
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP PTAN
IL
Enumeration date
07/19/2016
Last updated
07/30/2021
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