Provider Demographics
NPI:1679348122
Name:PETTYJOHN, BILLIE SUE
Entity type:Individual
Prefix:
First Name:BILLIE
Middle Name:SUE
Last Name:PETTYJOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3516 GLENGARY LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1516
Mailing Address - Country:US
Mailing Address - Phone:513-560-6063
Mailing Address - Fax:
Practice Address - Street 1:9478 LONGREN CT
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6028
Practice Address - Country:US
Practice Address - Phone:513-907-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant