Provider Demographics
NPI:1265918445
Name:DILLON, SHEKINA T (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHEKINA
Middle Name:T
Last Name:DILLON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10467 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4634
Mailing Address - Country:US
Mailing Address - Phone:228-374-2494
Mailing Address - Fax:
Practice Address - Street 1:3446 POPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2421
Practice Address - Country:US
Practice Address - Phone:228-374-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902683363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily