Provider Demographics
NPI:1356446579
Name:ROYSTER, LUCY KIMBALL (PA-C)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:KIMBALL
Last Name:ROYSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3759
Mailing Address - Country:US
Mailing Address - Phone:828-328-2901
Mailing Address - Fax:828-327-6223
Practice Address - Street 1:1205 N CENTER ST
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3759
Practice Address - Country:US
Practice Address - Phone:828-328-2901
Practice Address - Fax:828-327-6223
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant