Mary Kristine Willis, P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA07332 Issued in TX

Practice address

1935 Medical District Dr
Dallas, TX 75235-7701

Phone

(214) 456-7000

NPI assigned

Jul 22, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Collin Emergency Medicine Associates PA

  • Emergency Medicine Physician
  • Plano, TX
  • NPI 1912163882
  NPD (past)
• Telehealth Services USA

  • Pediatrics Physician
  • Truckee, CA
  • NPI 1275035263
  NPD (past)

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

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1083992267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9408 LANSHIRE DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752383410",
            "telephone_number": "469-417-8213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 MEDICAL DISTRICT DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357701",
            "telephone_number": "214-456-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Biltmore Way Ste 109",
            "address_purpose": "LOCATION",
            "city": "Coral Gables",
            "state": "FL",
            "postal_code": "331345724",
            "country_code": "US",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8300 Esters Blvd Ste 900",
            "address_purpose": "LOCATION",
            "city": "Irving",
            "state": "TX",
            "postal_code": "750632233",
            "country_code": "US",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Ala Moana Blvd Ste 7400",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968134902",
            "country_code": "US",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "MARY",
        "middle_name": "KRISTINE",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-22",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9119067",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA07332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina J Willis, LPC
• Dessica Monique Willis
• Fatema Willis, MD
• Jennifer Willis, M.S., M.B.A.
• John Willis, M.D.
• Nicole Willis
• Toni Willis, MD
• Yolanda Laron Willis, RN
• Anna Willison, D.D.S.
• Julia Willison

• Physician Assistant in Dallas, TX
• Providers in Dallas, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.

Verify at the official NPI Registry.