Individual
WILLIAM WYATT WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
126 TRIVETTE DR, SUITE 102, PIKEVILLE, KY 41501-1275
(606) 432-2202
(606) 432-2429
Mailing address
126 TRIVETTE DR, SUITE 102, PIKEVILLE, KY 41501-1275
(606) 432-2202
(606) 432-2429
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02719
KY
207Q00000X
Family Medicine Physician
Primary
1592
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6403711200
—
KY
Enumeration date
07/17/2006
Last updated
08/12/2010
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