Provider Demographics
NPI:1639707706
Name:SKEENS, BILLIE
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:SKEENS
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 1:101 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OH
Mailing Address - Zip Code:45326-9803
Mailing Address - Country:US
Mailing Address - Phone:937-634-9682
Mailing Address - Fax:
Practice Address - Street 1:101 E 5TH ST
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:OH
Practice Address - Zip Code:45326-9803
Practice Address - Country:US
Practice Address - Phone:937-634-9682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4306843374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty