Provider Demographics
NPI:1063781029
Name:LILLY, SHERRI JO (PA)
Entity type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:JO
Last Name:LILLY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 KNOTBREAK RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5414
Mailing Address - Country:US
Mailing Address - Phone:540-444-5670
Mailing Address - Fax:
Practice Address - Street 1:1 ARH LN
Practice Address - Street 2:STE. 201
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-444-5670
Practice Address - Fax:540-444-5669
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-21
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant