NPIMap

Individual provider Active NPI

Willard Jason Fiessinger, APRN

  • Family Nurse Practitioner
  • Benton, KY
National Provider Identifier
1619010444
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3005118 Issued in KY
Practice address
83 Wellness Way Ste 101&201
Benton, KY 42025-7156
Phone
(270) 527-0045
Fax
(270) 527-0075
NPI assigned
Feb 14, 2007
Last updated
Dec 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3005118 KY Primary

Addresses

Primary practice location

83 Wellness Way Ste 101&201
Benton, KY 42025-7156

Mailing address

83 Wellness Way Ste 101&201
Benton, KY 42025-7156

Other identifiers 2

IdentifierTypeStateIssuer
7100052530MedicaidKY
000000602049OtherKYBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070720000156 KY Practitioner - Nurse Practitioner 6507967585 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
May accept Medicare assignment
Group practices
Mercy Health Physicians Kentucky LLCGroup PAC ID 1153488648, 20 clinicians

Practice addresses (Care Compare)

83 Wellness Way
Benton, KY 42025-7156
Phone (270) 527-8601

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health-Lourdes Hospital LLC Current Accepting new patients
Mercy Health-Lourdes Hospital LLC CurrentSince Jan 1, 2024 Accepting new patients
Mercy Health-Lourdes Hospital LLC CurrentSince Jan 1, 2024 Accepting new patients
Mercy Health Physicians Kentucky LLC CurrentSince Dec 7, 2011 Accepting new patients
Mercy Health-Lourdes Hospital LLC Past Accepting new patients

Locations

83 Wellness Way
Benton, KY 42025
Phone (270) 527-8601

83 Wellness Way
Ste 101201
Benton, KY 42025
Phone (270) 527-0045

1530 Lone Oak Rd
Paducah, KY 42003
Phone (270) 444-2444

1532 Lone Oak Rd
Ste 245
Paducah, KY 42003
Phone (270) 538-5537

100 Medical Center Dr
Princeton, KY 42445
Phone (270) 365-0300

Interoperability endpoints

  • Direct secure messaging: jfiessinger53467@direct.bsmhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1619010444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 WELLNESS WAY STE 101&201",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420257156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 WELLNESS WAY STE 101&201",
            "city": "BENTON",
            "state": "KY",
            "postal_code": "420257156",
            "telephone_number": "270-527-0045",
            "fax_number": "270-527-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIESSINGER",
        "first_name": "WILLARD",
        "middle_name": "JASON",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3005118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100052530",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000602049",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton, KY

Sources for this page

Verify at the official NPI Registry.