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NPI Code Detail

MEDICARE: KENNETH BILLINGSLEY

MEDICARE: KENNETH BILLINGSLEY
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
1106S00000XBehavior TechnicianTX
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1588120257
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH BILLINGSLEY
Provider Business Mailing Address
First Line : 2790 KELLER HICKS RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-9610
Country : US
Telephone Number : 940-222-8556
Fax Number :
Provider Business Practice Location Address
First Line : 2790 KELLER HICKS RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-9610
Country : US
Telephone Number : 940-222-8556
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2019
Last Update Date : 03/31/2021

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Directions to “ KENNETH BILLINGSLEY ” Practice Location

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