Provider Demographics
NPI:1902514037
Name:LAIL, AERIAL BROOKE (PA)
Entity Type:Individual
Prefix:
First Name:AERIAL
Middle Name:BROOKE
Last Name:LAIL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AERIAL
Other - Middle Name:BROOKE
Other - Last Name:BROCKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1501 TATE BLVD SE
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-0038
Mailing Address - Country:US
Mailing Address - Phone:828-612-7772
Mailing Address - Fax:
Practice Address - Street 1:214 18TH ST SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1363
Practice Address - Country:US
Practice Address - Phone:828-322-5172
Practice Address - Fax:828-322-6963
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant