Provider Demographics
NPI:1396245742
Name:MAYO, BILLIESUE (AGNP-BC)
Entity type:Individual
Prefix:
First Name:BILLIESUE
Middle Name:
Last Name:MAYO
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5826 E FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5020
Mailing Address - Country:US
Mailing Address - Phone:208-318-1619
Mailing Address - Fax:208-318-1612
Practice Address - Street 1:5826 E FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5020
Practice Address - Country:US
Practice Address - Phone:208-318-1619
Practice Address - Fax:208-318-1612
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID57993363L00000X, 363LA2100X, 363LA2200X, 363LW0102X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1770129322Medicaid
OR1396245742Medicaid
ID1396245742Medicaid