Healthcare Provider Details

I. General information

NPI: 1356722946
Provider Name (Legal Business Name): AMY LACREST LOCKLEAR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 NC-711
PEMBROKE NC
28372
US

IV. Provider business mailing address

3009 DANIEL MCLEOD RD
RED SPRINGS NC
28377-9635
US

V. Phone/Fax

Practice location:
  • Phone: 910-966-4500
  • Fax:
Mailing address:
  • Phone: 910-258-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31815
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007660
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5007660
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: