Jack Andrew Will

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1651 W Rosedale St
Fort Worth, TX 76104-7437

Phone

(817) 257-4212

NPI assigned

Mar 24, 2025

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 FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1742774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742774400000",
    "number": "1386445278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1651 W ROSEDALE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 W ROSEDALE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047437",
            "telephone_number": "817-257-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILL",
        "first_name": "JACK",
        "middle_name": "ANDREW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-03-24",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Wilkinson, DMD
• Kallie Wilkinson, MS, CCC-SLP
• Mary Christine Wilkinson, NP
• Kenneth Wilks, D.O.
• Lance A. Wilks, CRNA
• Maya Willams
• Fawn Marie Willard, FNP
• John Edward Willard, MD
• Erin Colleen Willbanks, PMHNP
• Braden Chase Willburn, RN

• Student in an Organized Health Care Education/Training Program in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Student in an Organized Health Care Education/Training Program in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 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.