Provider Demographics
NPI:1750639761
Name:PARKER, BILLY RAY JR (LPN)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:RAY
Last Name:PARKER
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1135
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-0635
Mailing Address - Country:US
Mailing Address - Phone:516-300-2288
Mailing Address - Fax:
Practice Address - Street 1:2 BABYLON TPKE APT 21
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-2168
Practice Address - Country:US
Practice Address - Phone:516-300-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292261164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse