Healthcare Provider Details

I. General information

NPI: 1770279317
Provider Name (Legal Business Name): VICTORIA DILLARD MAGUIRE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TORI DILLARD MSN

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40506-0007
US

IV. Provider business mailing address

1205 KENESAW VILLAGE DR
LEXINGTON KY
40515-1116
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax: 859-323-1080
Mailing address:
  • Phone: 270-796-0013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4028564
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1166218
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: