Active NPI
Denise Lynne Willer, RN
- Registered Nurse
- Kingston, TN
National Provider Identifier
1679130652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN112216
- Practice address
- 629 Gallaher Rd
Kingston, TN 37763-4215 - Phone
- (865) 376-3416
- NPI assigned
- May 24, 2019
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN112216 | TN | Primary |
Addresses
Primary practice location
629 Gallaher Rd
Kingston, TN 37763-4215
Mailing address
629 Gallaher Rd
Kingston, TN 37763-4215
Phone (865) 376-3416
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RN112216 | Other | TN | RN LICENSE |
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN112216 | TN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558656000000",
"number": "1679130652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "629 GALLAHER RD",
"city": "KINGSTON",
"state": "TN",
"postal_code": "377634215",
"telephone_number": "865-376-3416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "629 GALLAHER RD",
"city": "KINGSTON",
"state": "TN",
"postal_code": "377634215",
"telephone_number": "865-376-3416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLER",
"first_name": "DENISE",
"middle_name": "LYNNE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-24",
"last_updated": "2019-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TN",
"license": "RN112216",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE",
"identifier": "RN112216",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingston, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.