Active NPI
Ardelia Willis
- Other Technician
- Dallas, TX
National Provider Identifier
1588012967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 29433880
- Practice address
- 1612 Nokomis Ave
Dallas, TX 75224-3740 - Phone
- (469) 427-9531
- NPI assigned
- May 26, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Other Technician | 247200000X | 29433880 | TX | Primary |
Addresses
Primary practice location
1612 Nokomis Ave
Dallas, TX 75224-3740
Mailing address
1612 Nokomis Ave
Dallas, TX 75224-3740
Phone (469) 427-9531
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 |
|---|---|---|---|
| 29433880 | TX | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1464220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464220800000",
"number": "1588012967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1612 NOKOMIS AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752243740",
"telephone_number": "469-427-9531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1612 NOKOMIS AVE",
"city": "DALLAS",
"state": "TX",
"postal_code": "752243740",
"telephone_number": "469-427-9531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "ARDELIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-26",
"last_updated": "2016-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "TX",
"license": "29433880",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.