Provider Demographics
NPI:1770675969
Name:LOCKLEAR, ALEXANDRA MACKINLAY (PA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MACKINLAY
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FIG ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:23310-3342
Mailing Address - Country:US
Mailing Address - Phone:850-450-1056
Mailing Address - Fax:
Practice Address - Street 1:2 FIG ST
Practice Address - Street 2:
Practice Address - City:CAPE CHARLES
Practice Address - State:VA
Practice Address - Zip Code:23310-3342
Practice Address - Country:US
Practice Address - Phone:850-450-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant