Healthcare Provider Details

I. General information

NPI: 1376827097
Provider Name (Legal Business Name): MARY BILLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MAIN ST
DURANT OK
74701-5038
US

IV. Provider business mailing address

1001 W MAIN ST
DURANT OK
74701-5038
US

V. Phone/Fax

Practice location:
  • Phone: 580-924-7330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number370244121099
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: