Provider Demographics
NPI:1386336394
Name:LOCKLEAR, BRANDON LEE
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:LOCKLEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4857 OAKGROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28360-3179
Mailing Address - Country:US
Mailing Address - Phone:910-225-9539
Mailing Address - Fax:
Practice Address - Street 1:3650 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2139
Practice Address - Country:US
Practice Address - Phone:910-338-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLOCK-FLZZD363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner