Provider Demographics
NPI:1326210808
Name:LOCKLEAR, VELISSA M
Entity Type:Individual
Prefix:
First Name:VELISSA
Middle Name:M
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:691 OLD BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MAXTON
Mailing Address - State:NC
Mailing Address - Zip Code:28364-8904
Mailing Address - Country:US
Mailing Address - Phone:910-736-4800
Mailing Address - Fax:910-844-1035
Practice Address - Street 1:691 OLD BAKER RD
Practice Address - Street 2:
Practice Address - City:MAXTON
Practice Address - State:NC
Practice Address - Zip Code:28364-8904
Practice Address - Country:US
Practice Address - Phone:910-736-4800
Practice Address - Fax:910-844-1035
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant