Provider Demographics
NPI:1548334337
Name:DILLARD, BONNIE E (APN)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:E
Last Name:DILLARD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 MARION ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4845
Mailing Address - Country:US
Mailing Address - Phone:501-305-9826
Mailing Address - Fax:501-279-3089
Practice Address - Street 1:617 MARION ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4845
Practice Address - Country:US
Practice Address - Phone:501-305-9826
Practice Address - Fax:501-279-3089
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01554363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165031758Medicaid
AR5A379Medicare PIN
AR57297Medicare PIN