Nicole Lackey Dillon, MD, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

21324 Issued in WV

Legal business name

NICOLE LACKEY DILLON, MD, INC

Doing business as

Grayson Family Medicine

Practice address

77 Hospital Dr
Doctors Park Suite D
Logan, WV 25601-3451

Phone

(304) 752-9290

NPI assigned

Aug 7, 2012

Last updated

Aug 18, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nicole Lackey Dillon, M.D.NPI 1730118431

Title

President

Phone

(304) 752-9290

Specialties & licenses 1

Addresses

Other names 1

• Grayson Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nicole Lackey Dillon, MD

  • Family Medicine Physician
  • Logan, WV
  • NPI 1730118431
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1396092508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 HOSPITAL DR STE D",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013451",
            "telephone_number": "304-752-9290",
            "fax_number": "304-896-8682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 HOSPITAL DR",
            "address_2": "DOCTORS PARK SUITE D",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013451",
            "telephone_number": "304-752-9290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLE LACKEY DILLON, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-07",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "DILLON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "LACKEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-752-9290",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "21324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grayson Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grayson Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Beena Nagpal, M.D.
• National Vision, Inc.
• New Hope Counseling
• Amanda New
• Halie Newsome, LPC
• Okpani Martin Nnachi, MD
• Charles Nwanguma, M.D.
• Jennifer Marie O'Neal, PT, DPT
• Ohio Valley Physicians Inc
• Ohio Valley Physicians, Inc (OVP Health)

• Family Medicine Physician in Logan, WV
• Providers in Logan, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.