Provider Demographics
NPI:1396841417
Name:KILROY, LUKE KELLY (PA-C)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:KELLY
Last Name:KILROY
Suffix:
Gender:M
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 1:3200 NORTHLINE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7616
Mailing Address - Country:US
Mailing Address - Phone:336-273-7900
Mailing Address - Fax:336-275-0433
Practice Address - Street 1:3200 NORTHLINE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7616
Practice Address - Country:US
Practice Address - Phone:336-273-7900
Practice Address - Fax:336-275-0433
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS99477Medicare UPIN