Basic Information
| Provider Information | |||||||||
| NPI: | 1093144784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOCKLEAR | ||||||||
| FirstName: | MILLICENT | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 812 CANDY PARK RD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283729129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105210201 | ||||||||
| FaxNumber: | 9105210773 | ||||||||
| Practice Location | |||||||||
| Address1: | 812 CANDY PARK RD | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283729129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105210201 | ||||||||
| FaxNumber: | 9105210773 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2013 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5006573 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0200X | 5006573 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 5006573 | 01 | NC | FNP-C LICENSE | OTHER |