Jacqueline Eva Willis, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

CNP02617 Issued in NM

Practice address

4011 Barbara Loop SE Ste 203
Rio Rancho, NM 87124-1041

Phone

(505) 994-4503

Fax

(505) 891-1495

NPI assigned

Apr 3, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Jacqueline Eva Willis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Integrated Healthcare

  • Psychiatric/Mental Health Nurse Practitioner
  • Rio Rancho, NM
  • NPI 1659800894
  NPD Authorized official

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

{
    "created_epoch": "1428019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1073908281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 BARBARA LOOP SE STE 203",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241041",
            "telephone_number": "505-994-4503",
            "fax_number": "505-891-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 BARBARA LOOP SE STE 203",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871241041",
            "telephone_number": "505-994-4503",
            "fax_number": "505-891-1495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JACQUELINE",
        "middle_name": "EVA",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-03",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "CNP02617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "WILLIS",
            "middle_name": "EVA",
            "prefix": "MISS",
            "credential": "NURSE PRACTITIONER",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Monica A Williams, CCC-SLP
• Rodrick Demond Williams Jr.
• Ronald W Williams Sr., LADAC
• Sydney Williams, LSAA
• Bethany D'Aun Willis, LMFT
• Taloa Willis, PTA
• Kristina Willoughby, LMSW
• Willow Springs Dental Hygiene Clinic
• Gretchen Ann Wilson, MSOTRL
• Toby Elizabeth Wilson, AU.D.

• Psychiatric/Mental Health Nurse Practitioner in Rio Rancho, NM
• Providers in Rio Rancho, NM by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.