# JENNIFER R WILLIS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1043526064
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WD0400X | Diabetes Educator Registered Nurse | 1083742 | KY | — |
| 163WD0400X | Diabetes Educator Registered Nurse | 28178246A | IN | — |
| 363L00000X | Nurse Practitioner | 3006899 | KY | Yes |

## Other

- **Enumeration date:** 08/27/2010
- **Last updated:** 10/17/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000772805 | ANTHEM-NMFM | KY |
| 01 | — | 137155 | SIHO - NMFM | KY |
| 05 | — | 201009490 | — | IN |
| 01 | — | 50040392 | PASSPORT - NMFM | KY |
| 05 | — | 7100205410 | — | KY |