Provider Demographics
NPI:1063751386
Name:DILLARD, KAREN MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARIE
Last Name:DILLARD
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 1:2021 MOUNT PLEASANT ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-1438
Mailing Address - Country:US
Mailing Address - Phone:330-413-1156
Mailing Address - Fax:
Practice Address - Street 1:822 KUMHO DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9297
Practice Address - Country:US
Practice Address - Phone:330-576-0500
Practice Address - Fax:330-576-0467
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant