Provider Demographics
NPI:1063979490
Name:DILLARD, KOY ABSHIRE (RN/IBCLC)
Entity type:Individual
Prefix:
First Name:KOY
Middle Name:ABSHIRE
Last Name:DILLARD
Suffix:
Gender:F
Credentials:RN/IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14112 BOLD RUN HILL RD.
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-971-3947
Mailing Address - Fax:
Practice Address - Street 1:7233 THOMPSON MILL RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9081
Practice Address - Country:US
Practice Address - Phone:919-971-3947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC238317163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty