Willows of Jackson , LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WILLOWS OF JACKSON , LLC

Practice address

447 Cheyenne Dr
Jackson, TN 38305-3571

Phone

(731) 300-4688

Fax

(731) 300-4698

NPI assigned

Jan 16, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Larry Lee Nicholson IINPI 1053313338

Title

Owner

Phone

(731) 415-9368

Specialties & licenses 1

Addresses

Other names 2

• The Willows Doing business as
• The Willows of Jackson Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larry Lee Nicholson II, O.D.

  • Optometrist
  • Huntingdon, TN
  • NPI 1053313338
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1736985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1023829280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19870 MAIN ST E",
            "city": "HUNTINGDON",
            "state": "TN",
            "postal_code": "383443927",
            "telephone_number": "731-415-9368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "447 CHEYENNE DR",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053571",
            "telephone_number": "731-300-4688",
            "fax_number": "731-300-4698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOWS OF JACKSON , LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "NICHOLSON",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-415-9368",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Willows",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Willows of Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cristal Neferteria Willis-Hill, LPN
• Dakotah Willis, PA-C
• Darrelle Willis, M.S.
• Hunter Willis, DO
• William Arthur Willis, M.D.
• Tajuanna Wills, MED
• Anthony M Wilson, PE
• Arlene G Wilson, CRNA
• Dana Wilson, RN
• Donald A Wilson

• All providers in Jackson, TN
• Assisted Living Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.