Provider Demographics
NPI:1720760622
Name:SMALL, BILLY (RN)
Entity Type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:SMALL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ROPER MOUNTAIN ROAD EXT APT 224
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4825
Mailing Address - Country:US
Mailing Address - Phone:864-251-0996
Mailing Address - Fax:
Practice Address - Street 1:120 DILLON DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1018
Practice Address - Country:US
Practice Address - Phone:864-596-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87797163WC1500X, 251J00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse