Active NPI
Tisa Marie Williams
- Gerontology Nurse Practitioner
- Louisville, KY
National Provider Identifier
1649964107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 4036265
- Practice address
- 3999 Dutchmans LN Ste 7B
Louisville, KY 40207-4742 - Phone
- (502) 896-4791
- NPI assigned
- Jun 7, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | APRN.CNP.0033951 | OH | |
| Gerontology Nurse Practitioner | 363LG0600X | 4036265 | KY | Primary |
Addresses
Primary practice location
3999 Dutchmans LN Ste 7B
Louisville, KY 40207-4742
Mailing address
PO Box 776351
Chicago, IL 60677-6351
Phone (502) 559-9425
Other practice location 1
3315 Bexley Dr
Middletown, OH 45042-2570
Phone (937) 204-4043
Other practice location 2
3700 Southern Blvd Ste 300
Kettering, OH 45429-1265
Phone (937) 643-9299
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| FHIR URL | https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/ | ||
| Direct Messaging Address | twilliams575336@direct.ketteringhealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH, KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
3700 Southern Blvd
Suite 300
Kettering, OH 45429-1265
Phone (937) 558-3214
3999 Dutchmans LN
Suite 7B
Louisville, KY 40207-4742
Phone (502) 896-4711
Hospital & facility affiliations
- Norton Hospitals, Inc
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4036265 | KY | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kettering Independent Medical Group Inc | Current | Accepting new patients | |
| Community Medical Associates, Inc. | Current | Accepting new patients | |
| Community Medical Associates, Inc. | Current | Accepting new patients | |
| Community Medical Associates, Inc. | Current | Accepting new patients | |
| Community Medical Associates, Inc. | Past | Accepting new patients |
Locations
3 Audubon Plaza Dr
Ste 530
Louisville, KY 40217
Phone (502) 629-3820
3999 Dutchmans Ln
Ste 7B
Louisville, KY 40207
Phone (502) 896-4711
825 Barret Ave
Louisville, KY 40204
Phone (502) 272-5165
4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910
3700 Southern Blvd
Ste 300
Kettering, OH 45429
Phone (937) 395-8002
1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306
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 and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Louisville, KY
- NPI 1306983762
-
- Orthopaedic Surgery Physician
- Miamisburg, OH
- NPI 1629387865
-
- Family Medicine Physician
- Louisville, KY
- NPI 1245312503
-
- Internal Medicine Physician
- Louisville, KY
- NPI 1881192409
-
- Internal Medicine Physician
- Louisville, KY
- NPI 1588614994
Hospital & facility affiliations 14
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1043348808
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1447388335
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1699514463
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1831195908
-
- General Acute Care Hospital
- Louisville, KY
- NPI 1891799227
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1756166400000",
"number": "1649964107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 776351",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606776351",
"telephone_number": "502-559-9425",
"fax_number": "502-272-5339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3999 DUTCHMANS LN STE 7B",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402074742",
"telephone_number": "502-896-4791"
}
],
"practiceLocations": [
{
"address_1": "3315 Bexley Dr",
"address_purpose": "LOCATION",
"city": "Middletown",
"state": "OH",
"postal_code": "450422570",
"country_code": "US",
"telephone_number": "937-204-4043",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3700 Southern Blvd Ste 300",
"address_purpose": "LOCATION",
"city": "Kettering",
"state": "OH",
"postal_code": "454291265",
"country_code": "US",
"telephone_number": "937-643-9299",
"fax_number": "937-643-2343",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILLIAMS",
"first_name": "TISA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-07",
"last_updated": "2025-08-26",
"certification_date": "2025-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "OH",
"license": "APRN.CNP.0033951",
"primary": false
},
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "KY",
"license": "4036265",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
"affiliation": "N",
"address_1": "3700 Southern Blvd Ste 300",
"city": "Kettering",
"state": "OH",
"country_code": "US",
"postal_code": "454291265",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "twilliams575336@direct.ketteringhealth.org",
"affiliation": "N",
"address_1": "3700 Southern Blvd Ste 300",
"city": "Kettering",
"state": "OH",
"country_code": "US",
"postal_code": "454291265",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.