Provider Demographics
NPI:1821152901
Name:LOCKLEAR, LEVERNE (PA)
Entity Type:Individual
Prefix:
First Name:LEVERNE
Middle Name:
Last Name:LOCKLEAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6155
Mailing Address - Country:US
Mailing Address - Phone:615-565-1733
Mailing Address - Fax:615-296-0151
Practice Address - Street 1:16526 NC HIGHWAY 87 W
Practice Address - Street 2:
Practice Address - City:TAR HEEL
Practice Address - State:NC
Practice Address - Zip Code:28392-8608
Practice Address - Country:US
Practice Address - Phone:910-872-5720
Practice Address - Fax:910-872-5739
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC87553Medicare UPIN