Kourtney Marie Willett, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA12883 Issued in TX

Practice address

912 Walnut Hill Dr
Longview, TX 75605-5052

Phone

(903) 291-6300

NPI assigned

Jul 23, 2019

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 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

Physician Assistant

State licenses

Practice roles

Locations

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.

• Dallas ENT & Allergy Center P a

  • Otolaryngology Physician
  • Dallas, TX
  • NPI 1073575080
  Medicare reassignment
• Dallas ENT and Allergy Center

  • Physician Assistant
  • Dallas, TX
  • NPI 1417198854
  NPD
• Ryan M Guillory MD PA

  • Otolaryngology Physician
  • Longview, TX
  • NPI 1184159055
  NPD

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763424000000",
    "number": "1326691957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 WALNUT HILL DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055052",
            "telephone_number": "903-291-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 WALNUT HILL DR",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756055052",
            "telephone_number": "903-291-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLETT",
        "first_name": "KOURTNEY",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-23",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA12883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeri L Wilkerson, PHARMD
• Stefanie Lynn Wilkerson, RD, CSG, LD
• David Alan Wilkinson, D.D.S.
• Stacy Leigh Wilkinson, DO
• Willem H. Fahrenbruck, LPC, PLLC
• Williams Pediatric Therapy, PLLC
• Joycelyn Sheri Williams Thomas, PH.D.
• Aimee Rebecca Williams-Wilbanks, SLP ASSISTANT
• Bailey Williams
• Blake Thomas Williams, O.D.

• Surgical Physician Assistant in Longview, TX
• Providers in Longview, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2025; 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.