Provider Demographics
NPI:1740819549
Name:LARKER, JACKELINE CHAPARRO LORENZO (DO)
Entity type:Individual
Prefix:
First Name:JACKELINE
Middle Name:CHAPARRO LORENZO
Last Name:LARKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACKELINE
Other - Middle Name:
Other - Last Name:CHAPARRO LORENZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:6102 GRACE PARK DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6003
Practice Address - Country:US
Practice Address - Phone:919-235-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-02413207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740819549Medicaid