Active NPI
Pamelia Fowler Willis, PH.D.
- Clinical Neuropsychologist
- Fort Sam Houston, TX
National Provider Identifier
1245212828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- 22368
- Practice address
- 3551 Roger Brooke Dr
Fort Sam Houston, TX 78234 - Phone
- (201) 916-8087
- NPI assigned
- Nov 18, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 22368 | TX | Primary |
Addresses
Primary practice location
3551 Roger Brooke Dr
Fort Sam Houston, TX 78234
Mailing address
13239 Trentwood
San Antonio, TX 78231-2256
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22368 | TX | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533686400000",
"number": "1245212828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13239 TRENTWOOD",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782312256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3551 ROGER BROOKE DR",
"city": "FORT SAM HOUSTON",
"state": "TX",
"postal_code": "78234",
"telephone_number": "201-916-8087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "PAMELIA",
"middle_name": "FOWLER",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-18",
"last_updated": "2018-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "TX",
"license": "22368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Sam Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.