MEDICARE: DR. KATHERINE L BILLINGSLEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME0044346	FL

General Provider Information

NPI Number	:	1336132133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE L BILLINGSLEY M.D.

Provider Business Mailing Address
First Line	:	12276 SAN JOSE BLVD
Second Line	:	SUITE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8628
Country	:	US
Telephone Number	:	904-268-5561
Fax Number	:	904-292-9170

Provider Business Practice Location Address
First Line	:	12276 SAN JOSE BLVD
Second Line	:	SUITE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8628
Country	:	US
Telephone Number	:	904-268-5506
Fax Number	:	904-292-9170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	02/02/2012

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