Individual
BILLY R WINDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
103 MEDICAL PARK FL 2, HATTIESBURG, MS 39401-9042
(601) 268-5630
(601) 579-3285
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 268-5630
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R810054
MS
363LF0000X
Family Nurse Practitioner
Primary
810054
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114640
—
MS
01
—
640507572KX
AMERICAN ADMIN GROUP
MS
Enumeration date
08/30/2006
Last updated
05/09/2024
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