Kimberly D Willis, ACNP RN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

2015 Issued in SC

Practice address

166 Stoneridge Drive
Columbia, SC 29210

Phone

(803) 461-3000

Fax

(803) 461-4903

NPI assigned

Feb 22, 2007

Sex

Female

Sole proprietor

No

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 SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

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.

• South Carolina Oncology Assoc PA

  • Hematology & Oncology Physician
  • Columbia, SC
  • NPI 1467406918
  Medicare reassignment NPD

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467936000000",
    "number": "1558496448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 STONERIDGE DRIVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29210",
            "telephone_number": "803-461-3000",
            "fax_number": "803-461-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 STONERIDGE DRIVE",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29210",
            "telephone_number": "803-461-3000",
            "fax_number": "803-461-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "KIMBERLY",
        "middle_name": "D",
        "credential": "ACNP RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2016-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "2015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal L Willis, MSN, RN
• Damian Willis
• Daquorl Lamonte Willis, RBT
• Deidra Willis, A- GNP
• Ebony Rene Willis, RBT
• Rachel Willis, RN
• Samuel M Willis Jr., MD
• Yvannah Mae Garcia Willis, PA-C
• Elizabeth Willits
• Carmen Willm, OT

• Nurse Practitioner in Columbia, SC
• Providers in Columbia, SC by specialty
• Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; 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.