Healthcare Provider Details

I. General information

NPI: 1417571258
Provider Name (Legal Business Name): AARON LOCKMILLER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 06/07/2020
Certification Date: 06/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N MLK BLVD
CLOVIS NM
88101-9401
US

IV. Provider business mailing address

2301 N MLK BLVD
CLOVIS NM
88101-9401
US

V. Phone/Fax

Practice location:
  • Phone: 575-762-4455
  • Fax:
Mailing address:
  • Phone: 575-762-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number60326
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: