Provider Demographics
NPI:1174940100
Name:PRATER, BILLIE JEAB
Entity type:Individual
Prefix:MS
First Name:BILLIE
Middle Name:JEAB
Last Name:PRATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOMBRE CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2469
Mailing Address - Country:US
Mailing Address - Phone:850-532-9898
Mailing Address - Fax:
Practice Address - Street 1:2711 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1366
Practice Address - Country:US
Practice Address - Phone:850-769-6001
Practice Address - Fax:850-769-6003
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5581891164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse