Healthcare Provider Details

I. General information

NPI: 1447555685
Provider Name (Legal Business Name): DOLLY BRISCOE ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 N STATE HIGHWAY 121
MT ZION IL
62549-1219
US

IV. Provider business mailing address

1045 N STATE HIGHWAY 121
MT ZION IL
62549-1219
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-2085
  • Fax: 217-864-2324
Mailing address:
  • Phone: 217-864-2085
  • Fax: 217-864-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. KENDALL KAE DOLLY
Title or Position: PRESIDENT
Credential:
Phone: 217-454-5340