Provider Demographics
NPI:1003083536
Name:LORD, ELIZABETH D (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:LORD
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 1:840 OLD COUNTY HOME RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-9171
Mailing Address - Country:US
Mailing Address - Phone:252-459-3100
Mailing Address - Fax:
Practice Address - Street 1:100 NASH MEDICAL ARTS MALL
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1400
Practice Address - Country:US
Practice Address - Phone:252-451-3100
Practice Address - Fax:252-451-3141
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P21267OtherUPIN