Provider Demographics
NPI:1225303746
Name:JACOBS, ALLISON LOCKLEAR (FNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LOCKLEAR
Last Name:JACOBS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 LUDGATE ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2460
Mailing Address - Country:US
Mailing Address - Phone:910-272-3030
Mailing Address - Fax:910-618-1009
Practice Address - Street 1:4303 LUDGATE ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358
Practice Address - Country:US
Practice Address - Phone:910-272-3030
Practice Address - Fax:910-618-1009
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005580363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1225303746OtherBCBSNC
NCF0212263OtherAANP
NC7006022Medicaid
NC1225303746OtherBCBSNC