Tina H Willis, MA, RD, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

875565 Issued in IN

Practice address

8402 Harcourt Rd
Ste 500
Indianapolis, IN 46260-2074

Phone

(317) 871-0000

Fax

(317) 871-0010

NPI assigned

Jan 5, 2010

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1262649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262649600000",
    "number": "1205166899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD",
            "address_2": "STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602074",
            "telephone_number": "317-871-0000",
            "fax_number": "317-871-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8402 HARCOURT RD",
            "address_2": "STE 500",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602074",
            "telephone_number": "317-871-0000",
            "fax_number": "317-871-0010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "TINA",
        "middle_name": "H",
        "name_prefix": "Mrs.",
        "credential": "MA, RD, CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-05",
        "last_updated": "2010-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IN",
            "license": "875565",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rashunda Rene Willis, LPN
• Rebecca Willis, LCSW
• Rieketta Danyelle Willis
• Sydney Willis
• Thomas J Willis, MD
• Jazzmin Willliams
• Grace Willmann
• Cheyanne Willoughby
• Willow Treatment and Recovery Center, LLC
• Willow Tree Counseling & Consulting, LLC

• Registered Dietitian in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Registered Dietitian in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2010; 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.