Provider Demographics
NPI:1376252908
Name:BILLY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-2016
Mailing Address - Country:US
Mailing Address - Phone:580-889-6459
Mailing Address - Fax:405-366-0482
Practice Address - Street 1:263 E. COURT ST.
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:USA
Practice Address - Zip Code:74525
Practice Address - Country:UM
Practice Address - Phone:580-889-6459
Practice Address - Fax:405-366-0482
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist