Healthcare Provider Details

I. General information

NPI: 1114592417
Provider Name (Legal Business Name): LOCKMILLER HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NORTH PRINCE STREET SUITE C
CLOVIS NM
88101
US

IV. Provider business mailing address

608 NORTH PRINCE STREET SUITE C
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-742-8911
  • Fax: 575-742-8902
Mailing address:
  • Phone: 575-742-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AARON D LOCKMILLER
Title or Position: OWNER
Credential: NP
Phone: 575-742-8911