Active NPI
Mary Katherine Willis, RDN
- Registered Dietitian
- Wilmington, NC
National Provider Identifier
1669333704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 2517 Delaney Ave
Wilmington, NC 28403-6003 - Phone
- (910) 239-3562
- NPI assigned
- Nov 19, 2025
- Sex
- Unspecified or another gender identity
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
2517 Delaney Ave
Wilmington, NC 28403-6003
Mailing address
2517 Delaney Ave
Wilmington, NC 28403-6003
Phone (910) 239-3562
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040809000568 | NC | Practitioner - Registered Dietitian Or Nutrition Professional | 1850363011 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763510400000",
"number": "1669333704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2517 DELANEY AVE",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284036003",
"telephone_number": "910-239-3562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2517 DELANEY AVE",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284036003",
"telephone_number": "910-239-3562"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "MARY KATHERINE",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "X",
"enumeration_date": "2025-11-19",
"last_updated": "2025-11-19",
"certification_date": "2025-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.