Individual provider Active NPI

Carl Austin Willeford Jr., FNP-C

  • Family Nurse Practitioner
  • Nacogdoches, TX
National Provider Identifier
1063465409
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP114322 Issued in TX
Practice address
2702 N University Dr
Nacogdoches, TX 75965-2922
Phone
(936) 221-5138
Fax
(936) 221-5150
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP114322 TX Primary

Addresses

Primary practice location

2702 N University Dr
Nacogdoches, TX 75965-2922

Mailing address

2702 N University Dr
Nacogdoches, TX 75965-2922
Phone (936) 221-5138

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060119000907 TX Practitioner - Nurse Practitioner 2961426705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1516 S 31St St
Suite B
Temple, TX 76504-6752
Phone (254) 778-6626

Hospital & facility affiliations

  • Accentcare Home Health of Texas Home health agency, Nacogdoches, TX, CCN 679108
  • Reliant at Home Home health agency, Lufkin, TX, CCN 747328
  • Nacogdoches Medical Center Hospital, Nacogdoches, TX, CCN 450656
  • Nacogdoches Memorial Hospital Hospital, Nacogdoches, TX, CCN 450508

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Walk-in Clinic, LLC CurrentSince Dec 4, 2017 Accepting new patients
Deuteronomy Past Accepting new patients
Dailey Medical Clinic Past Accepting new patients

Locations

3226 N University Dr
Ste 300
Nacogdoches, TX 75965
Phone (317) 796-6393

2702 N University Dr
Nacogdoches, TX 75965
Phone (936) 205-5805

1516 S 31st St
Ste B
Temple, TX 76504
Phone (254) 778-6626

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GIJFAD/Endpoint/GIJFAD

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1063465409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2702 N UNIVERSITY DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759652922",
            "telephone_number": "936-221-5138",
            "fax_number": "936-221-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2702 N UNIVERSITY DR",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759652922",
            "telephone_number": "936-221-5138",
            "fax_number": "936-221-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLEFORD",
        "first_name": "CARL",
        "middle_name": "AUSTIN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP114322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

Verify at the official NPI Registry.