Basic Information
| Provider Information | |||||||||
| NPI: | 1265403604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUILD | ||||||||
| FirstName: | BILLY | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 608 NW 9TH ST STE 3000 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052727337 | ||||||||
| FaxNumber: | 4052313059 | ||||||||
| Practice Location | |||||||||
| Address1: | 608 NW 9TH ST STE 3000 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052727337 | ||||||||
| FaxNumber: | 4052313059 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R0064928 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 100160480A | 05 | OK | MEDICAID |