Active NPI
Michael Scott Willsey, RN
- Prevention Professional
- Elmira, NY
National Provider Identifier
1073303897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 495439
- Practice address
- 100 Washington St
Elmira, NY 14901-2849 - Phone
- (607) 737-4700
- NPI assigned
- May 7, 2025
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 495439 | NY | Primary |
Addresses
Primary practice location
100 Washington St
Elmira, NY 14901-2849
Mailing address
1115 Richard St
Elmira, NY 14904-2720
Phone (607) 333-0772
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 495439 | NY | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1746576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746576000000",
"number": "1073303897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 RICHARD ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149042720",
"telephone_number": "607-333-0772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WASHINGTON ST",
"city": "ELMIRA",
"state": "NY",
"postal_code": "149012849",
"telephone_number": "607-737-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLSEY",
"first_name": "MICHAEL",
"middle_name": "SCOTT",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-07",
"last_updated": "2025-05-07",
"certification_date": "2025-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Prevention Professional",
"state": "NY",
"license": "495439",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elmira, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.