MEDICARE: CARRIE DILLARD FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP134971	TX

General Provider Information

NPI Number	:	1467960047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE DILLARD FNP-C

Provider Business Mailing Address
First Line	:	4302 CHRISMAC WAY
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-4950
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5900 S HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4820
Country	:	US
Telephone Number	:	817-289-7600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	01/17/2018

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Directions to “ CARRIE DILLARD FNP-C” Practice Location

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