Provider Demographics
NPI:1285250670
Name:MCCOLLOUGH, DYLAN REESE (CRNP)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:REESE
Last Name:MCCOLLOUGH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1010
Mailing Address - Country:US
Mailing Address - Phone:334-493-5713
Mailing Address - Fax:334-493-5750
Practice Address - Street 1:918 DRAYTON AVE
Practice Address - Street 2:
Practice Address - City:ELBA
Practice Address - State:AL
Practice Address - Zip Code:36323-1448
Practice Address - Country:US
Practice Address - Phone:334-493-5713
Practice Address - Fax:334-493-5750
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALF06200571207Q00000X
AL1-140157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine