Provider Demographics
NPI:1023676905
Name:DILLARD, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:BUSHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4646 HIGHWAY 31 W
Mailing Address - Street 2:
Mailing Address - City:COTTONTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37048-4852
Mailing Address - Country:US
Mailing Address - Phone:615-294-2939
Mailing Address - Fax:
Practice Address - Street 1:4646 HIGHWAY 31 W
Practice Address - Street 2:
Practice Address - City:COTTONTOWN
Practice Address - State:TN
Practice Address - Zip Code:37048-4852
Practice Address - Country:US
Practice Address - Phone:615-294-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily