Provider Demographics
NPI:1356216006
Name:LOCKLEAR, TANYEL
Entity type:Individual
Prefix:
First Name:TANYEL
Middle Name:
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 1:921 S 401 BYPASS HWY
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5089
Mailing Address - Country:US
Mailing Address - Phone:910-861-0400
Mailing Address - Fax:910-795-4257
Practice Address - Street 1:921 S 401 BYPASS HWY
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5089
Practice Address - Country:US
Practice Address - Phone:910-861-0400
Practice Address - Fax:910-795-4257
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88832164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty