Healthcare Provider Details

I. General information

NPI: 1124955000
Provider Name (Legal Business Name): TEAYRA NICOLE DILLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W UNIVERSITY DR
ROCHESTER HILLS MI
48307-1863
US

IV. Provider business mailing address

3153 DOTHAN ST
MEMPHIS TN
38118-3515
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-4805
  • Fax:
Mailing address:
  • Phone: 901-679-8425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: