Provider Demographics
NPI:1225152200
Name:YOCUM, LISA KAY (PAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:YOCUM
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22545B HWY 17 NORTH
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-3173
Mailing Address - Country:US
Mailing Address - Phone:910-329-0300
Mailing Address - Fax:910-329-0307
Practice Address - Street 1:22545B HWY 17 NORTH
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3173
Practice Address - Country:US
Practice Address - Phone:910-329-0300
Practice Address - Fax:910-329-0307
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102312363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP78302Medicare UPIN