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NPI Code Detail

MEDICARE: BILLY JOE GOLDEN JR. NP

MEDICARE: BILLY JOE GOLDEN JR. NP
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
1363L00000XNurse Practitioner1-091623AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13267OTHERRNP RX NUMBER

General Provider Information

NPI Number : 1700182755
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILLY JOE GOLDEN JR. NP
Provider Business Mailing Address
First Line : 174 HIGHWAY 113
Second Line :
City : FLOMATON
State : AL
Zip : 36441-4556
Country : US
Telephone Number : 251-296-2456
Fax Number :
Provider Business Practice Location Address
First Line : 174 HIGHWAY 113
Second Line :
City : FLOMATON
State : AL
Zip : 36441-4556
Country : US
Telephone Number : 251-296-2456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2011
Last Update Date : 01/09/2019

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