Provider Demographics
NPI:1023332020
Name:LILLEY, BROOKE REGISTER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:REGISTER
Last Name:LILLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:LILLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6500 CREEDMOOR RD.
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613
Mailing Address - Country:US
Mailing Address - Phone:919-825-4000
Mailing Address - Fax:919-803-3601
Practice Address - Street 1:6500 CREEDMOOR RD.
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613
Practice Address - Country:US
Practice Address - Phone:919-825-4000
Practice Address - Fax:919-803-3601
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02181363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical