Provider Demographics
NPI:1750418968
Name:TIMBROOK-DILLOW, KAREN M (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:TIMBROOK-DILLOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-643-3378
Mailing Address - Fax:
Practice Address - Street 1:900 OLD WINSTON RD
Practice Address - Street 2:SUITE 222
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9964
Practice Address - Country:US
Practice Address - Phone:336-992-1234
Practice Address - Fax:336-993-9963
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0299885OtherFEDERAL DEA
MT0299885OtherFEDERAL DEA