MEDICARE: LISA MARIE DILLON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	154738	TN

General Provider Information

NPI Number	:	1962360982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE DILLON FNP-C

Provider Business Mailing Address
First Line	:	3300 WILLIAMS ENTERPRISE DR
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-4201
Country	:	US
Telephone Number	:	931-528-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 WILLIAMS ENTERPRISE DR
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-4201
Country	:	US
Telephone Number	:	931-528-9222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2026
Last Update Date	:	01/10/2026

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