Provider Demographics
NPI:1023870508
Name:LOCKLEAR PRIME AND URGENT CARE
Entity type:Organization
Organization Name:LOCKLEAR PRIME AND URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:910-775-9292
Mailing Address - Street 1:22 CHAYLEAJACE DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-1019
Mailing Address - Country:US
Mailing Address - Phone:919-316-5462
Mailing Address - Fax:
Practice Address - Street 1:10461 NC HIGHWAY 711
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372
Practice Address - Country:US
Practice Address - Phone:910-775-9292
Practice Address - Fax:910-775-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty