Provider Demographics
NPI:1659982734
Name:BILLS, JEANNETTE MARIE
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:BILLS
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 1:2929 MOFFETT AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4109
Mailing Address - Country:US
Mailing Address - Phone:940-782-4374
Mailing Address - Fax:
Practice Address - Street 1:2929 MOFFETT AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-4109
Practice Address - Country:US
Practice Address - Phone:940-782-4374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123689164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse