Willis, Jennifer R

Willis, Jennifer R is an individual health care provider with primary practice located at 601 S Floyd St Ste 700 , Louisville KY 40202-1845. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Diabetes Educator, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Willis, Jennifer R can be contacted via phone (502) 629-7181.

Contact Information

Primary practice address
601 S Floyd St Ste 700 Louisville KY 40202-1845
Phone: (502) 629-7181
Fax: (502) 629-6957
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Diabetes Educator 163WD0400X 28178246A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 3006899 Kentucky
Nursing Service Providers / Diabetes Educator 163WD0400X 1083742 Kentucky

Profile Details

NPI number 1043526064
LBN Legal business name Willis, Jennifer R
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 27th, 2010
Last updated Oct 17th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043526064 NPPES
Kentucky Other 000000772805 ANTHEM-NMFM
Kentucky Other 137155 ANTHEM-NMFM
Kentucky Other 50040392 ANTHEM-NMFM
Kentucky MEDICAID 201009490 ANTHEM-NMFM
Kentucky MEDICAID 7100205410 ANTHEM-NMFM

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