Provider Demographics
NPI:1700182755
Name:GOLDEN, BILLY JOE JR (NP)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:JOE
Last Name:GOLDEN
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 HIGHWAY 113
Mailing Address - Street 2:
Mailing Address - City:FLOMATON
Mailing Address - State:AL
Mailing Address - Zip Code:36441-4556
Mailing Address - Country:US
Mailing Address - Phone:251-296-2456
Mailing Address - Fax:
Practice Address - Street 1:174 HIGHWAY 113
Practice Address - Street 2:
Practice Address - City:FLOMATON
Practice Address - State:AL
Practice Address - Zip Code:36441-4556
Practice Address - Country:US
Practice Address - Phone:251-296-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-091623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3267OtherRNP RX NUMBER