Jacob Willis, NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

1008163 Issued in TX

Practice address

5026 Pool Rd
Denison, TX 75020-2803

Phone

(903) 465-3624

NPI assigned

Oct 27, 2021

Sex

Male

Sole proprietor

Yes

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 TX

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

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FDAGBA

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.

• Texomacare Specialty Physicians

  • Cardiovascular Disease Physician
  • Denison, TX
  • NPI 1548541733

  Single Specialty

  Medicare reassignment NPD
• Texomacare

  • Family Medicine Physician
  • Denison, TX
  • NPI 1740233592

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1635292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1255095014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5026 POOL RD",
            "city": "DENISON",
            "state": "TX",
            "postal_code": "750202803",
            "telephone_number": "903-465-3624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5026 POOL RD",
            "city": "DENISON",
            "state": "TX",
            "postal_code": "750202803",
            "telephone_number": "903-465-3624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JACOB",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-27",
        "last_updated": "2021-10-27",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "1008163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cristi A Williams, NP
• Ronald Murph Williams Sr., M.D.
• Glen Robert Willie, MD
• Debora Lynn Willis-Tenczar, R.PH.
• Guy W. Willis, D.D.S.
• Shelbi Lorene Wilson, DC
• Wanda N Wilson, RN
• Women'S Center of Sherman, P.a.
• Kathryn Woodruff, PA-C
• Olivia Hope Workman, PTA

• Acute Care Nurse Practitioner in Denison, TX
• Providers in Denison, TX by specialty
• Acute Care Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2021; 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.