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General NPI Number Information
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NPI Number | 1386336394
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Entity Type | Individual
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Provider Name | BRANDON LEE LOCKLEAR
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Gender | Male
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 3650 CAPE CENTER DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-2139
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Country | US
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Telephone | 910-338-5313
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Fax |
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Provider Business Mailing Address
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Address Line | 4857 OAKGROVE CHURCH RD
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City | LUMBERTON
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State | NC
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Zip | 28360-3179
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Country | US
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Telephone | 910-225-9539
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LOCK-FLZZD
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License Number State | NC
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