Provider Demographics
NPI:1245983790
Name:WEARY, BILLY RAY JR
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:RAY
Last Name:WEARY
Suffix:JR
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 1:16520 M P PLANCHE RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5769
Mailing Address - Country:US
Mailing Address - Phone:985-773-8603
Mailing Address - Fax:
Practice Address - Street 1:16520 M P PLANCHE RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-5769
Practice Address - Country:US
Practice Address - Phone:985-773-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007738900343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)