MEDICARE: MRS. TINA MARIE BILLBERRY FNP-BC

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	211645	LA

General Provider Information

NPI Number	:	1437789203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TINA MARIE BILLBERRY FNP-BC

Provider Business Mailing Address
First Line	:	321 W SHORE DR
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-7007
Country	:	US
Telephone Number	:	318-312-0392
Fax Number	:

Provider Business Practice Location Address
First Line	:	1587 N BOLTON AVE STE 1100
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-4255
Country	:	US
Telephone Number	:	318-445-9823
Fax Number	:

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

Provider Enumeration Date	:	01/21/2020
Last Update Date	:	01/21/2020

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