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General NPI Number Information
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NPI Number | 1083033195
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Entity Type | Individual
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Provider Name | LACIE DILLON PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 103 W MAIN ST STE C
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City | COOKEVILLE
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State | TN
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Zip | 38506-2310
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Country | US
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Telephone | 931-218-6463
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Fax |
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Provider Business Mailing Address
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Address Line | 2691 LACIE DR
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City | COOKEVILLE
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State | TN
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Zip | 38506-5078
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Country | US
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Telephone | 931-265-4248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2514
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License Number State | TN
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