Active NPI
Kyndel Rae Willis
- Pharmacist
- Altus, OK
National Provider Identifier
1497503056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20506
- Practice address
- 1132 N Main St
Altus, OK 73521-3122 - Phone
- (580) 477-1316
- NPI assigned
- May 8, 2024
- Last updated
- May 8, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 20506 | OK | Primary |
Addresses
Primary practice location
1132 N Main St
Altus, OK 73521-3122
Mailing address
111 Surry Rd
Elk City, OK 73644-5801
Phone (469) 964-6129
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20506 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
1132 N Main St
Altus, OK 73521
Phone (580) 477-1316
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715126400000",
"number": "1497503056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 SURRY RD",
"city": "ELK CITY",
"state": "OK",
"postal_code": "736445801",
"telephone_number": "469-964-6129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1132 N MAIN ST",
"city": "ALTUS",
"state": "OK",
"postal_code": "735213122",
"telephone_number": "580-477-1316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "KYNDEL",
"middle_name": "RAE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-08",
"last_updated": "2024-05-08",
"certification_date": "2024-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "20506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Altus, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.