Provider Demographics
NPI:1386318418
Name:DILLON, TABATHA MECHELLE (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:MECHELLE
Last Name:DILLON
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:TN
Mailing Address - Zip Code:38574-1122
Mailing Address - Country:US
Mailing Address - Phone:931-839-2244
Mailing Address - Fax:931-839-3047
Practice Address - Street 1:410 W CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:TN
Practice Address - Zip Code:38574-1122
Practice Address - Country:US
Practice Address - Phone:931-839-2244
Practice Address - Fax:931-839-3047
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29820363LP0808X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty