Provider Demographics
NPI:1669020046
Name:DILLARD, ERICA RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:RENEE
Last Name:DILLARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-6007
Mailing Address - Country:US
Mailing Address - Phone:901-425-0200
Mailing Address - Fax:901-213-9868
Practice Address - Street 1:2922 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-6007
Practice Address - Country:US
Practice Address - Phone:901-425-0200
Practice Address - Fax:901-213-9868
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily