Individual
KELLY JO LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
670 W ACADEMY ST, RANDLEMAN, NC 27317-9748
(336) 498-8500
(336) 498-8522
Mailing address
670 W ACADEMY ST, RANDLEMAN, NC 27317-9748
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
292083
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
292083
RN
NC
01
—
5019530
NP
NC
Enumeration date
01/12/2024
Last updated
09/13/2024
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