Provider Demographics
NPI:1942493366
Name:FANNING, BILLY WAYNE
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:WAYNE
Last Name:FANNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 CARPENTER COURT
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3532
Mailing Address - Country:US
Mailing Address - Phone:661-665-2356
Mailing Address - Fax:661-665-2356
Practice Address - Street 1:1106 CARPENTER COURT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3532
Practice Address - Country:US
Practice Address - Phone:661-665-2356
Practice Address - Fax:661-665-2356
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08 00106496172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver