Provider Demographics
NPI:1740655406
Name:DILLARD, DEVONN
Entity type:Individual
Prefix:
First Name:DEVONN
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 GUS THOMASSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5417
Mailing Address - Country:US
Mailing Address - Phone:469-730-0044
Mailing Address - Fax:469-730-0046
Practice Address - Street 1:2620 GUS THOMASSON RD STE 102
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5417
Practice Address - Country:US
Practice Address - Phone:469-730-0044
Practice Address - Fax:469-730-0046
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP-144701363LP0808X
TX633233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse