Provider Demographics
NPI:1215717160
Name:LOCKLEAR, DEBORAH JANE (FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JANE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7672
Mailing Address - Country:US
Mailing Address - Phone:910-691-1637
Mailing Address - Fax:
Practice Address - Street 1:342 LOOP RD
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7672
Practice Address - Country:US
Practice Address - Phone:910-691-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95082401163W00000X
NC268375163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse