1023870508 NPI number — LOCKLEAR PRIME AND URGENT CARE

Table of content: SKYE ATHENA JONES QMHP (NPI 1134844434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023870508 NPI number — LOCKLEAR PRIME AND URGENT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOCKLEAR PRIME AND URGENT CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023870508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 CHAYLEAJACE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28372-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-316-5462
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10461 NC HIGHWAY 711
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-775-9292
Provider Business Practice Location Address Fax Number:
910-775-9444
Provider Enumeration Date:
01/29/2024

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKLEAR
Authorized Official First Name:
MILLICENT
Authorized Official Middle Name:
JOY
Authorized Official Title or Position:
OWENER/PROVIDER
Authorized Official Telephone Number:
910-775-9292

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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