MEDICARE: LAUREN ASHLEIGH LOCKLEAR CLARK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-06943	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NCW457A	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245776160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ASHLEIGH LOCKLEAR CLARK PA

Provider Business Mailing Address
First Line	:	PO BOX 296
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-0296
Country	:	US
Telephone Number	:	910-410-0010
Fax Number	:	828-538-4441

Provider Business Practice Location Address
First Line	:	1521 OWEN PARK LN
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3454
Country	:	US
Telephone Number	:	910-223-7420
Fax Number	:	910-223-7452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	04/09/2026

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Directions to “ LAUREN ASHLEIGH LOCKLEAR CLARK PA” Practice Location

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