Healthcare Provider Details

I. General information

NPI: 1023411758
Provider Name (Legal Business Name): BILLIE JO KILLION FNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

IV. Provider business mailing address

9254 W RISING SUN DR
PENDLETON IN
46064-8664
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-8004
  • Fax:
Mailing address:
  • Phone: 317-910-2301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28202276A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: