Demetrius Jermaine Willis, MBA, MS, RD, LD, CPT

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

DT81138 Issued in TX

Practice address

225 E Sonterra Blvd
San Antonio, TX 78258-3992

Phone

(210) 477-2799

NPI assigned

Aug 10, 2009

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

Credentials

Master of Business Administration, Master of Science

State licenses

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

{
    "created_epoch": "1249862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249862400000",
    "number": "1508098567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6422 MERLIN WAY",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782334661",
            "telephone_number": "121-048-5841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E SONTERRA BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583992",
            "telephone_number": "210-477-2799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "DEMETRIUS",
        "middle_name": "JERMAINE",
        "name_prefix": "Mr.",
        "credential": "MBA, MS, RD, LD, CPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-10",
        "last_updated": "2009-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "TX",
            "license": "DT81138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Willie
• Alex Clark Willingham, M.D.
• Davida Lynn Willingham, LPC
• Francisca Bench Willingham, M.A, LBA, BCBA
• Ann Elisabeth Willis, LPTA
• Dennis Earl Willis, MD
• Evelyn L Willis, MSN. RN
• George Christopher Willis, MD
• Hayley Jane Willis, LPC
• Mary Kay Willis, SLPA

• Registered Dietitian in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Registered Dietitian in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2009; 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.