Provider Demographics
NPI:1225077423
Name:CARLISLE, LAUREN KEELY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:KEELY
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N MERRIMON AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1368
Mailing Address - Country:US
Mailing Address - Phone:828-348-8232
Mailing Address - Fax:855-323-6740
Practice Address - Street 1:40 N MERRIMON AVE STE 117
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1368
Practice Address - Country:US
Practice Address - Phone:828-348-8232
Practice Address - Fax:855-323-6740
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00215208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1483460Medicaid
NC1483460Medicare ID - Type Unspecified
NC1483460Medicaid