Deidra Willis, A- GNP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

20835 Issued in SC

Practice address

6439 Garners Ferry Rd
Columbia, SC 29209-1638

Phone

(803) 776-4000

NPI assigned

Apr 29, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1493424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493424000000",
    "number": "1114452901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 KATRINA CT",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290736924",
            "telephone_number": "803-413-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6439 GARNERS FERRY RD",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292091638",
            "telephone_number": "803-776-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DEIDRA",
        "credential": "A- GNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-29",
        "last_updated": "2017-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "SC",
            "license": "20835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda L Willis, PSY.D
• Beverly Willis
• Crystal L Willis, MSN, RN
• Damian Willis
• Daquorl Lamonte Willis, RBT
• Ebony Rene Willis, RBT
• Kimberly D Willis, ACNP RN
• Rachel Willis, RN
• Samuel M Willis Jr., MD
• Yvannah Mae Garcia Willis, PA-C

• Primary Care Nurse Practitioner in Columbia, SC
• Providers in Columbia, SC by specialty
• Primary Care Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.