Basic Information
Provider Information | |||||||||
NPI: | 1609292127 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LUCAS | ||||||||
FirstName: | RHONDA | ||||||||
MiddleName: | WELLS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2150 NC HIGHWAY 65 | ||||||||
Address2: |   | ||||||||
City: | REIDSVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 273209609 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3364279022 | ||||||||
FaxNumber: | 3364279030 | ||||||||
Practice Location | |||||||||
Address1: | 439 US HIGHWAY 158 W | ||||||||
Address2: |   | ||||||||
City: | YANCEYVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 273798304 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3366949331 | ||||||||
FaxNumber: | 3366944209 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/07/2014 | ||||||||
LastUpdateDate: | 02/02/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/02/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 87154 | NC | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.