Provider Demographics
NPI:1407212699
Name:CARLISLE, BRANDON COLBY (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:COLBY
Last Name:CARLISLE
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 1:1385 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-5130
Mailing Address - Country:US
Mailing Address - Phone:252-537-9176
Mailing Address - Fax:
Practice Address - Street 1:306 BECKER DR.
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870
Practice Address - Country:US
Practice Address - Phone:252-537-9268
Practice Address - Fax:252-537-0900
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant