Provider Demographics
NPI:1689499659
Name:COUCH, BILLY
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:
Last Name:COUCH
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 1:4811 E CRAIG RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2578
Mailing Address - Country:US
Mailing Address - Phone:702-357-8317
Mailing Address - Fax:702-357-8317
Practice Address - Street 1:4811 E CRAIG RD UNIT D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-2578
Practice Address - Country:US
Practice Address - Phone:702-357-8317
Practice Address - Fax:702-357-8317
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant