Kenneth Dean Willis, M.D.

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

12320 Issued in AL

Practice address

3007 Memorial Pkwy SW
Huntsville, AL 35801-5393

Phone

(256) 882-2003

Fax

(256) 705-4630

NPI assigned

Nov 21, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Covenant Recovery Center LLC

  dba Covenant Recovery Center

  • Addiction (Substance Use Disorder) Counselor
  • Huntsville, AL
  • NPI 1366959561
  NPD Authorized official
• Major Hospital

  • General Acute Care Hospital
  • Shelbyville, IN
  • NPI 1174555692
  NPD (past)

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483660800000",
    "number": "1053486704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18084",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358048084",
            "telephone_number": "256-882-2003",
            "fax_number": "256-705-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3007 MEMORIAL PKWY SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358015393",
            "telephone_number": "256-882-2003",
            "fax_number": "256-705-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KENNETH",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2017-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AL",
            "license": "12320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529908240",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley M Willingham
• Emily Willingham
• Claire Elise Willis
• Jasmine Willis, PHARMD
• Kaitlyn Russell Willis, CRNP
• Mina Salafranca Willis
• Sarah Gray Willis, CRNP
• Willow Tree Counseling, LLC
• Bradley Wills
• Alecie Wilson

• Pain Medicine (Anesthesiology) Physician in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Pain Medicine (Anesthesiology) Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.