Willis Clinic

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

E5031 Issued in AR

Legal business name

WILLIS CLINIC

Doing business as

Willis Clinic PLLC

Practice address

616 W Lee Ave
Osceola, AR 72370-3002

Phone

(870) 563-2545

Fax

(870) 563-2482

NPI assigned

Jun 28, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Timothy W Willis

Title

Coo/Practice Manager

Phone

(870) 563-2545

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Willis Clinic PLLC Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Willis Clinic Express

  • Urgent Care Clinic/Center
  • Osceola, AR
  • NPI 1174959795

  Member Of

  NPD member

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15827/brand/1/csg/1/fhir/r4

Practitioners 3

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

• Carolyn Coleman, FNP

  • Family Nurse Practitioner
  • Jonesboro, AR
  • NPI 1407388267
  Medicare reassignment NPD
• Sherita D Willis, MD

  • Family Medicine Physician
  • Osceola, AR
  • NPI 1740326610
  Medicare reassignment NPD
• Jiva Marie Pate, APRN

  • Adult Medicine Physician
  • Hondo, TX
  • NPI 1053811752
  NPD (past)

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1063619567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 W LEE AVE",
            "city": "OSCEOLA",
            "state": "AR",
            "postal_code": "723703002",
            "telephone_number": "870-563-2545",
            "fax_number": "870-563-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 W LEE AVE",
            "city": "OSCEOLA",
            "state": "AR",
            "postal_code": "723703002",
            "telephone_number": "870-563-2545",
            "fax_number": "870-563-2482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-28",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "COO/PRACTICE MANAGER",
        "authorized_official_telephone_number": "870-563-2545",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AR",
            "license": "E5031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165422001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willis Clinic PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paula White, RN
• Harry Warren Whitis, DDS
• Monica L. Wilburn
• Libby Wilhite, RN
• Charles Williams Jr., MTTPP
• Willis Clinic Express
• Sherita D Willis, MD
• Anna Walker Willoughby, LAC
• Mark K Wilson, DDS
• Millie Diane Wimberley

• Primary Care Clinic/Center in Osceola, AR
• Providers in Osceola, AR by specialty
• Primary Care Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.