Provider Demographics
NPI:1912487489
Name:DILLARD, BROOKE ELAINE (FNP-C, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELAINE
Last Name:DILLARD
Suffix:
Gender:F
Credentials:FNP-C, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-5032
Mailing Address - Country:US
Mailing Address - Phone:918-774-6888
Mailing Address - Fax:
Practice Address - Street 1:916 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-5032
Practice Address - Country:US
Practice Address - Phone:918-774-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005679363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner