Individual
NERISSA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3954 N KICKAPOO AVE STE 1, SHAWNEE, OK 74804-1698
(405) 857-8280
Mailing address
3954 N KICKAPOO AVE STE 1, SHAWNEE, OK 74804-1698
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-415811
OK
Other
Enumeration date
03/06/2025
Last updated
03/06/2025
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