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General NPI Number Information
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NPI Number | 1851828677
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Entity Type | Individual
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Provider Name | DEBORAH DILLARD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 629 NUCKOLLS RD
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City | BOLIVAR
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State | TN
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Zip | 38008-1599
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Country | US
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Telephone | 731-658-3388
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Fax | 731-659-3131
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Provider Business Mailing Address
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Address Line | 445 NUCKOLLS RD
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City | BOLIVAR
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State | TN
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Zip | 38008-1539
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Country | US
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Telephone | 731-658-3388
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Fax | 731-659-4079
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95302
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 22871
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License Number State | TN
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