Provider Demographics
NPI:1700699550
Name:THOMPSON, KELLIE LOCKLEAR (MSN, PMHNP)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:LOCKLEAR
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSN, PMHNP
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:LOCKLEAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:350 PEE DEE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4932
Mailing Address - Country:US
Mailing Address - Phone:704-986-1500
Mailing Address - Fax:986-704-1725
Practice Address - Street 1:350 PEE DEE AVE STE 101
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4945
Practice Address - Country:US
Practice Address - Phone:910-740-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227556163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health