| Doctor Name: | BILLIE RENEE RUSSELL |
| NPI Number: | 1063836807 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1-127877 |
| Business Practice Address: | 25850 Main St Ardmore, TN - 384493156 |
| Business Phone Number: | 9314276052 |
| Business Fax Number: | 9314276053 |
| Mailing Address: | 5315 Millennium Dr Nw, HUNTSVILLE |
| State: | AL |
| Postal Code: | 358062458 |
| Phone Number: | 2569646700 |
| Fax Number: | 2569646735 |
| NPI Enumeration Date: | 02/14/2014 |
| NPI Last Update Date: | 02/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 1-127877 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |