Provider Demographics
NPI:1073224135
Name:MARCANTEL, BILLY WAYNE (APRN)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:WAYNE
Last Name:MARCANTEL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 LAURA CIR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-3761
Mailing Address - Country:US
Mailing Address - Phone:337-563-5066
Mailing Address - Fax:
Practice Address - Street 1:100 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1038
Practice Address - Country:US
Practice Address - Phone:850-609-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA224346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA002995240Medicaid