Provider Demographics
NPI:1689964967
Name:LOCKLEAR, DENISE BUSBIN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:BUSBIN
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2109 VALLEYGATE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3571
Mailing Address - Country:US
Mailing Address - Phone:910-486-8880
Mailing Address - Fax:910-486-8886
Practice Address - Street 1:2109 VALLEYGATE DR STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3571
Practice Address - Country:US
Practice Address - Phone:910-486-8880
Practice Address - Fax:910-486-8886
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-02826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant