Provider Demographics
NPI:1083457196
Name:SIZEMORE, BILLY
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:SIZEMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WAYMON HOLLEN RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-5701
Mailing Address - Country:US
Mailing Address - Phone:606-250-1703
Mailing Address - Fax:
Practice Address - Street 1:225 N 3RD ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1108
Practice Address - Country:US
Practice Address - Phone:606-250-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist