Provider Demographics
NPI:1700858925
Name:DILLINGHAM, DENISE (PA-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HEALTH PARK DR FL HP2
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-373-7600
Mailing Address - Fax:877-767-2310
Practice Address - Street 1:600 S POLLARD ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-3439
Practice Address - Country:US
Practice Address - Phone:540-777-2360
Practice Address - Fax:540-777-2379
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-001411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700858925Medicaid
VA1700858925Medicaid
VAVVF994AMedicare UPIN
VAVVF994BMedicare PIN