Healthcare Provider Details

I. General information

NPI: 1659577211
Provider Name (Legal Business Name): LAUREN DENISE LYERLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROWN ST
FAITH NC
28041
US

IV. Provider business mailing address

611 MOCKSVILLE AVE.
SALISBURY NC
28144-2705
US

V. Phone/Fax

Practice location:
  • Phone: 704-216-7060
  • Fax: 704-603-8981
Mailing address:
  • Phone: 704-633-7220
  • Fax: 704-647-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-00936
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00936
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: