Individual provider Active NPI

Leslie Amanda Locklear, FNP-C

  • Family Nurse Practitioner
  • Ketchikan, AK
National Provider Identifier
1336469469
Registry record updated Mar 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1146 Issued in AK
Practice address
3100 Tongass Ave
Ketchikan, AK 99901-5746
Phone
(907) 228-8140
Fax
(907) 228-8440
NPI assigned
Jun 11, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1146 AK Primary

Addresses

Primary practice location

3100 Tongass Ave
Ketchikan, AK 99901-5746

Mailing address

1115 SE 164TH Ave Dept 358
Vancouver, WA 98683-8004
Phone (360) 729-1462

Other identifiers 1

IdentifierTypeStateIssuer
1022353MedicaidAK

Other names 1

  • Leslie Wheeless Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, AK2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101118001399 TX Practitioner - Nurse Practitioner 2769678598 Reassigns benefits to 1 organization
I20160427000750 AK Practitioner - Nurse Practitioner 2769678598

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ketchikan Indian CorporationGroup PAC ID 8426043761, 13 clinicians

Practice addresses (Care Compare)

2960 Tongass Ave
Ketchikan, AK 99901-5742
Phone (907) 228-9200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.12 of 100Reported as group
Quality
81.91
Promoting interoperability
100
Improvement activities
40
Cost
40.93

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1146AKMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Ketchikan Indian Corporation CurrentSince Jun 1, 2025 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Power of Wellness Health Services LLC PastSince Oct 13, 2019 Accepting new patients

Locations

2960 Tongass Ave
Ketchikan, AK 99901
Phone (907) 228-4900

3100 Tongass Ave
Ketchikan, AK 99901
Phone (907) 225-4104

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553126400000",
    "number": "1336469469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 SE 164TH AVE DEPT 358",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986838004",
            "telephone_number": "360-729-1462",
            "fax_number": "360-729-3104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 TONGASS AVE",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999015746",
            "telephone_number": "907-228-8140",
            "fax_number": "907-228-8440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKLEAR",
        "first_name": "LESLIE",
        "middle_name": "AMANDA",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-11",
        "last_updated": "2019-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "1146",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022353",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LESLIE",
            "last_name": "WHEELESS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ketchikan, AK

Sources for this page

Verify at the official NPI Registry.