Provider Demographics
NPI:1063836807
Name:RUSSELL, BILLIE RENEE
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:RENEE
Last Name:RUSSELL
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 1:565 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148-4630
Mailing Address - Country:US
Mailing Address - Phone:205-255-6206
Mailing Address - Fax:
Practice Address - Street 1:565 STATE ST
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-4630
Practice Address - Country:US
Practice Address - Phone:205-255-6206
Practice Address - Fax:205-255-7180
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127877363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health