Active NPI
Jacob Willis
- Family Nurse Practitioner
- Butte, MT
National Provider Identifier
1437782810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- NUR-APRN-LIC-157870
- Practice address
- 445 Centennial Ave
Butte, MT 59701-2870 - Phone
- (406) 723-4075
- NPI assigned
- Feb 13, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NUR-APRN-LIC-157870 | MT | Primary |
Addresses
Primary practice location
445 Centennial Ave
Butte, MT 59701-2870
Mailing address
445 Centennial Ave
Butte, MT 59701-2870
Phone (406) 723-4075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NUR-APRN-LIC-157870 | MT | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648425600000",
"number": "1437782810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "445 CENTENNIAL AVE",
"city": "BUTTE",
"state": "MT",
"postal_code": "597012870",
"telephone_number": "406-723-4075",
"fax_number": "406-496-6035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "445 CENTENNIAL AVE",
"city": "BUTTE",
"state": "MT",
"postal_code": "597012870",
"telephone_number": "406-723-4075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "JACOB",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-02-13",
"last_updated": "2022-03-28",
"certification_date": "2022-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MT",
"license": "NUR-APRN-LIC-157870",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Butte, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.