Provider Demographics
NPI:1861700809
Name:LOCKLEAR, ASHLEY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 COMMERCE PLZ
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7386
Mailing Address - Country:US
Mailing Address - Phone:910-521-2900
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:1709 BERWICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5547
Practice Address - Country:US
Practice Address - Phone:910-521-2900
Practice Address - Fax:910-775-9165
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1861700809OtherCOVENTRY/WELLPATH
NC163UVOtherBCBSNC
NC1861700809OtherMEDCOST
NCP01128154OtherRAILROAD MEDICARE
NC1861700809OtherAETNA
NC8101348Medicaid
NC0010-02525OtherNORTH CAROLINA MEDICAL BOARD
NC1861700809OtherHEALTHNET/TRICARE
NC1861700809OtherFIRST CAROLINA CARE
NC1861700809OtherUNITED HEALTH CARE
NCNC5018A,B,C,DMedicare PIN