Provider Demographics
NPI:1124837372
Name:DILLINGHAM, TERESA KAY (MSN, RN, CDCES)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:KAY
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:MSN, RN, CDCES
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:KAY
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:270-825-7374
Mailing Address - Fax:270-825-7225
Practice Address - Street 1:200 CLINIC DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1661
Practice Address - Country:US
Practice Address - Phone:270-825-7374
Practice Address - Fax:270-825-7225
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1033308163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator