Diba Tillery, RN, IBCLC

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

664335 Issued in TX

Practice address

301 Brushy Creek Rd Ste 106
Cedar Park, TX 78613-3151

Phone

(512) 765-9599

NPI assigned

Feb 16, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Babies 411 LLC

  dba My Pure Delivery

  • Lactation Consultant (Registered Nurse)
  • Cedar Park, TX
  • NPI 1013394055
  NPD Authorized official

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

{
    "created_epoch": "1487203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616716800000",
    "number": "1710426259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9311 N FM 620 RD # 247",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787264129",
            "telephone_number": "512-765-9959",
            "fax_number": "888-227-7057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 BRUSHY CREEK RD STE 106",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786133151",
            "telephone_number": "512-765-9599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLERY",
        "first_name": "DIBA",
        "credential": "RN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-16",
        "last_updated": "2021-03-26",
        "certification_date": "2021-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "TX",
            "license": "L-36079",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "664335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Thompson, AUD
• Bonnie Thomson, FNP
• Laura Thoreson, PSY.D
• Kimberly Sue Throckmorton, AUD
• Tiffany Simon Kondoff, DDS, PLLC (Cedar Park Premier Dentistry)
• Tillman Physical Therapy & Sports Training
• Tillman Physical Therapy & Sports Training Center, Inc
• Michael Ray Tillman, MPT, CSCS, CERT, MDT
• Michelle L Tilton
• Timberland Medical Group

• Registered Nurse in Cedar Park, TX
• Providers in Cedar Park, TX by specialty
• Registered Nurse in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.