Provider Demographics
NPI:1760934483
Name:TANK-DILLINGHAM, PAMELA JEAN (DNP)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:TANK-DILLINGHAM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 AUDUBON DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1201
Mailing Address - Country:US
Mailing Address - Phone:828-222-0280
Mailing Address - Fax:828-800-9580
Practice Address - Street 1:17 AUDUBON DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1201
Practice Address - Country:US
Practice Address - Phone:828-222-0280
Practice Address - Fax:828-800-9580
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC245812363L00000X, 363LF0000X, 363LP0808X
NC5008740363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEAN-0024953OtherRX AUTH
KY3016217OtherBOARD OF NURSING APRN
DEL8-0010280OtherBOARD OF NURSING APRN
NH085572-23OtherBOARD OF NURSING APRN
MDAC004089OtherBOARD OF NURSING APRN
PASP024259OtherBOARD OF NURSING APRN
MDN112496OtherRX AUTH
WV9543OtherRX AUTH
MARN2361086OtherBOARD OF NURSING APRN
PANPPA048146OtherRX AUTH
CT11217OtherBOARD OF NURSING APRN
WA109634OtherBOARD OF NURSING APRN
NC5008740OtherBOARD OF NURSING APRN
CTCSP.0082145OtherRX AUTH
MAMCS007586BOtherRX AUTH