MEDICARE: AMY KATHERINE BILLINGSLEA LAT

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	2255A2300X	Athletic Trainer	AT6354	TX

General Provider Information

NPI Number	:	1417598129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY KATHERINE BILLINGSLEA LAT

Provider Business Mailing Address
First Line	:	401 E LYNNWOOD LN
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75604-1740
Country	:	US
Telephone Number	:	903-399-4852
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 SPRING HILL RD
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75605-2822
Country	:	US
Telephone Number	:	903-446-3317
Fax Number	:

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

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	10/03/2019

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