Provider Demographics
NPI:1184175739
Name:DILLON, CASEY (PA)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:
Last Name:DILLON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 ATOKA LN
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38572-6603
Mailing Address - Country:US
Mailing Address - Phone:931-510-3645
Mailing Address - Fax:
Practice Address - Street 1:29 TAYLOR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4527
Practice Address - Country:US
Practice Address - Phone:931-484-6061
Practice Address - Fax:931-484-6062
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3100OtherSTATE OF TN PA LICENSE