Provider Demographics
NPI:1922475227
Name:DILLON HART ACNP, LLC
Entity Type:Organization
Organization Name:DILLON HART ACNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-458-3857
Mailing Address - Street 1:PO BOX 5234
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5234
Mailing Address - Country:US
Mailing Address - Phone:318-458-3857
Mailing Address - Fax:318-314-2046
Practice Address - Street 1:1800 IRVING PLACE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-458-3857
Practice Address - Fax:318-929-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-22
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1814393Medicaid
LA1814393Medicaid