Provider Demographics
NPI:1467925206
Name:DILLINGHAM, TEYANNA JOYCE
Entity Type:Individual
Prefix:
First Name:TEYANNA
Middle Name:JOYCE
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 N LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-4733
Mailing Address - Country:US
Mailing Address - Phone:864-582-2411
Mailing Address - Fax:864-512-3288
Practice Address - Street 1:1341 N LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4733
Practice Address - Country:US
Practice Address - Phone:864-582-2411
Practice Address - Fax:864-512-3288
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22330363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily