Individual
MRS. NICOLE LACKEY DILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
77 HOSPITAL DR STE D, LOGAN, WV 25601-3451
(304) 752-9290
(304) 896-8682
Mailing address
20 HOSPITAL DR, LOGAN, WV 25601-3452
(304) 831-1825
(304) 831-1828
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21324
WV
207Q00000X
Family Medicine Physician
39860
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1810172000
—
WV
Enumeration date
07/03/2006
Last updated
08/18/2022
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