Individual
JENNIFER R WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
601 S FLOYD ST STE 700, LOUISVILLE, KY 40202-1845
(502) 629-7181
(502) 629-6957
Mailing address
PO BOX 766351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
1083742
KY
163WD0400X
Diabetes Educator Registered Nurse
28178246A
IN
363L00000X
Nurse Practitioner
Primary
3006899
KY
Other
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
Enumeration date
08/27/2010
Last updated
10/17/2016
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