Provider Demographics
NPI:1972646552
Name:LILLARD, BRENDA LEE (MHS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEE
Last Name:LILLARD
Suffix:
Gender:F
Credentials:MHS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 SCOTTS CREEK ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5281
Mailing Address - Country:US
Mailing Address - Phone:828-586-8994
Mailing Address - Fax:828-586-3493
Practice Address - Street 1:538 SCOTTS CREEK ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5281
Practice Address - Country:US
Practice Address - Phone:828-586-8994
Practice Address - Fax:828-586-3493
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001873133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCL001873OtherLDN
NC165KGOtherBLUE CROSS BLUE SHIELD
NC885168OtherDIETETIC REGISTRATION