Shawn Dale Willis, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN66325-FNP-BC Issued in WV

Practice address

67 Vickers Branch Rd
Chapmanville, WV 25508-9716

Phone

(304) 855-1959

NPI assigned

Aug 3, 2016

Last updated

Sep 19, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in WV

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

• Direct secure messaging: swillis20757@gohealthupmc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cherokee Emergency Services, Inc.

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  • NPI 1982643938

  Nurse Practitioner

  Medicare reassignment NPD
• Health Care Alliance, Inc.

  • Emergency Medicine Physician
  • Beckley, WV
  • NPI 1730128760
  Medicare reassignment NPD
• Urgent Care, Inc.- West Virginia

  • Urgent Care Clinic/Center
  • South Charleston, WV
  • NPI 1912133315
  Medicare reassignment
• Urgent Care, Inc - West Virginia

  dba Urgent Care, Inc - West Virginia Logan

  • Urgent Care Clinic/Center
  • Logan, WV
  • NPI 1962885582
  NPD (past)

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

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1265985550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 VICKERS BRANCH RD",
            "city": "CHAPMANVILLE",
            "state": "WV",
            "postal_code": "255089716",
            "telephone_number": "304-855-1959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 VICKERS BRANCH RD",
            "city": "CHAPMANVILLE",
            "state": "WV",
            "postal_code": "255089716",
            "telephone_number": "304-855-1959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "123 Enterprise Dr",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "WV",
            "postal_code": "256013750",
            "country_code": "US",
            "telephone_number": "304-752-0183",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SHAWN",
        "middle_name": "DALE",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-03",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "APRN66325-FNP-BC",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "APRN66325-FNP-BC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendi Leann Watts, M.ED. COUNSELING
• Shiloh Webb
• Jeri West
• Cristina Williams, PHARM.D
• Brianna Williamson, LMT
• Melissa Ann Wolff, RN
• Destiney Wolford
• Carleton J Wood, OD
• Joyce Workman
• Kendra Workman

• Family Nurse Practitioner in Chapmanville, WV
• Providers in Chapmanville, WV by specialty
• Family Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.