Individual
KATHLEEN H. WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
52579 HIGHWAY 51 S, INDEPENDENCE, LA 70443-2231
(800) 377-8721
(304) 523-2241
Mailing address
PO BOX 65074, CHARLOTTE, NC 28265-0074
(800) 377-8721
(304) 523-2241
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD024877
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1576921
—
LA
Enumeration date
03/24/2006
Last updated
09/14/2007
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