Provider Demographics
NPI:1134828270
Name:PREVENTATIVE HEALTH NP IN FAMILY HEALTH LLP
Entity type:Organization
Organization Name:PREVENTATIVE HEALTH NP IN FAMILY HEALTH LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:910-474-7810
Mailing Address - Street 1:1323 CLIPPER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-6874
Mailing Address - Country:US
Mailing Address - Phone:910-474-7810
Mailing Address - Fax:
Practice Address - Street 1:1323 CLIPPER RD
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582
Practice Address - Country:US
Practice Address - Phone:910-474-7810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty