Provider Demographics
NPI:1962048074
Name:DILLARD, LAVONDA (FNP)
Entity type:Individual
Prefix:
First Name:LAVONDA
Middle Name:
Last Name:DILLARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 ELM ST STE 4210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7282
Mailing Address - Country:US
Mailing Address - Phone:469-607-8448
Mailing Address - Fax:
Practice Address - Street 1:1111 N INTERSTATE 35 E
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3509
Practice Address - Country:US
Practice Address - Phone:469-607-8448
Practice Address - Fax:469-607-8778
Is Sole Proprietor?:No
Enumeration Date:2019-11-24
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily