Active NPI
Alyssa Willis, CPM-TN
- Midwife
- Wilder, TN
National Provider Identifier
1073239422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- 117
- Practice address
- 760 Savage Boles Rd
Wilder, TN 38589-5030 - Phone
- (931) 261-6085
- NPI assigned
- Oct 18, 2022
- Last updated
- Oct 18, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | 117 | TN | Primary |
Addresses
Primary practice location
760 Savage Boles Rd
Wilder, TN 38589-5030
Mailing address
708 S Holly St
Monterey, TN 38574-1314
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 117 | TN | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666051200000",
"number": "1073239422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "708 S HOLLY ST",
"city": "MONTEREY",
"state": "TN",
"postal_code": "385741314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 SAVAGE BOLES RD",
"city": "WILDER",
"state": "TN",
"postal_code": "385895030",
"telephone_number": "931-261-6085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "ALYSSA",
"credential": "CPM-TN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-18",
"last_updated": "2022-10-18",
"certification_date": "2022-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "TN",
"license": "117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilder, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.