Provider Demographics
NPI:1659577211
Name:LYERLY, LAUREN DENISE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:DENISE
Last Name:LYERLY
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 1:611 MOCKSVILLE AVE.
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2705
Mailing Address - Country:US
Mailing Address - Phone:704-633-7220
Mailing Address - Fax:704-647-0515
Practice Address - Street 1:1000 BROWN ST
Practice Address - Street 2:
Practice Address - City:FAITH
Practice Address - State:NC
Practice Address - Zip Code:28041
Practice Address - Country:US
Practice Address - Phone:704-216-7060
Practice Address - Fax:704-603-8981
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00936363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00429768OtherRAIL ROAD MEDICARE
NC2770259Medicare PIN