Individual
MS. LUCINDA KELLEY BACKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.G.N.P.
Contact information
Practice address
114 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 765-5470
(336) 499-5428
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 765-5470
(336) 499-5428
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
800114
NC
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
800114
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7005670
—
NC
Enumeration date
08/01/2007
Last updated
10/28/2020
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