Provider Demographics
NPI:1770949984
Name:LOCKLEAR, VICTORIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2984
Mailing Address - Country:US
Mailing Address - Phone:910-674-4203
Mailing Address - Fax:910-674-4213
Practice Address - Street 1:3001 N ELM ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2984
Practice Address - Country:US
Practice Address - Phone:910-674-4203
Practice Address - Fax:910-674-4213
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant