Samuel Conner Willis, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-175937 Issued in AL

Practice address

84 Cropwell Drive
Pell City, AL 35128-7366

Phone

(205) 606-4273

NPI assigned

Mar 24, 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samuel.willis@581996630507524.direct.elationemr.com

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.

• Elixir Health Direct Primary Care LLC

  • Primary Care Nurse Practitioner
  • Pell City, AL
  • NPI 1053131532
  NPD Authorized official

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

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1427635630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 CROPWELL DRIVE",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "35128",
            "telephone_number": "205-813-2079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84 CROPWELL DRIVE",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351287366",
            "telephone_number": "205-606-4273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "SAMUEL",
        "middle_name": "CONNER",
        "name_prefix": "Mr.",
        "credential": "DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-24",
        "last_updated": "2023-05-09",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-175937",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joe F Willard, OTRL
• Linsey Steadman Williams, M.D.
• Marvin Earl Williams Jr., DPM
• Christy J Willis, ALC,NCC
• Kristen Cochran Willis
• Cassie Lynn Wilson, MS, CCC-SLP
• Chandra C Wilson, PT
• Jonathan Mark Windham, CRNP
• Emma Wood-Wright
• Catherine Word

• Family Nurse Practitioner in Pell City, AL
• Providers in Pell City, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.