Active NPI
Kaci Dawn Willis, M.S.
- Speech-Language Pathologist
- Eagletown, OK
National Provider Identifier
1053857722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP#P9074
- Practice address
- 110 Willis Spring Rd
Eagletown, OK 74734-3413 - Phone
- (870) 784-1147
- NPI assigned
- Jan 18, 2017
- Last updated
- Jan 18, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP#P9074 | AR | Primary |
| Speech-Language Pathologist | 235Z00000X | 112453 | TX |
Addresses
Primary practice location
110 Willis Spring Rd
Eagletown, OK 74734-3413
Mailing address
110 Willis Spring Rd
Eagletown, OK 74734-3413
Phone (870) 784-1147
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)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SP#P9074 | AR | MD | Speech-Language Pathologist |
| 112453 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484697600000",
"number": "1053857722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 WILLIS SPRING RD",
"city": "EAGLETOWN",
"state": "OK",
"postal_code": "747343413",
"telephone_number": "870-784-1147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 WILLIS SPRING RD",
"city": "EAGLETOWN",
"state": "OK",
"postal_code": "747343413",
"telephone_number": "870-784-1147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "KACI",
"middle_name": "DAWN",
"name_prefix": "Mrs.",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-01-18",
"last_updated": "2017-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AR",
"license": "SP#P9074",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "112453",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.