Active NPI
Jack Blanton Wills, M.S., P.A.
- Clinical Psychologist
- Eugene, OR
National Provider Identifier
1043464597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5052
- Practice address
- 1414 Kincaid St
Eugene, OR 97401-3737 - Phone
- (541) 505-2080
- NPI assigned
- Nov 11, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5052 | OR | Primary |
Addresses
Primary practice location
1414 Kincaid St
Eugene, OR 97401-3737
Mailing address
1414 Kincaid St
Eugene, OR 97401-3737
Phone (541) 505-2080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5052 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226361600000",
"number": "1043464597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1414 KINCAID ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974013737",
"telephone_number": "541-505-2080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 KINCAID ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974013737",
"telephone_number": "541-505-2080"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLS",
"first_name": "JACK",
"middle_name": "BLANTON",
"name_prefix": "Mr.",
"credential": "M.S., P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-11",
"last_updated": "2008-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "5052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.