NPIMap

Individual provider Active NPI

Tyler Willis, DNP, NP

  • Acute Care Nurse Practitioner
  • Coupeville, WA
National Provider Identifier
1689340515
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
AP61540212 Issued in WA
Practice address
121 N Main St
Coupeville, WA 98239
Phone
(360) 678-5151
NPI assigned
Aug 19, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP61540212 WA
Acute Care Nurse Practitioner 363LA2100X 29874 TN
Acute Care Nurse Practitioner 363LA2100X AP61540212 WA Primary

Addresses

Primary practice location

121 N Main St
Coupeville, WA 98239

Mailing address

4840 Davis Rd
Southaven, MS 38671-9635
Phone (901) 428-9900

Other practice location 1

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone (423) 224-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20240515000870 WA Practitioner - Nurse Practitioner 7113310020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
South Sound Inpatient Physicians PLLCGroup PAC ID 5991618738, 424 clinicians

Practice addresses (Care Compare)

101 N Main St
Coupeville, WA 98239-3413
Phone (360) 678-5151

1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone (360) 424-4111

330 S Stillaguamish Ave
Arlington, WA 98223-1642
Phone (360) 435-2133

407 14TH Ave SE
Puyallup, WA 98372-3770
Phone (253) 697-4000

Hospital & facility affiliations

  • Whidbeyhealth Medical Center Hospital, Coupeville, WA, CCN 501339

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP61540212WAMDNurse Practitioner
29874TNMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Sound Inpatient Physicians PLLC CurrentSince Apr 2, 2024 Accepting new patients
South Sound Inpatient Physicians PLLC Nurse Practitioner Current Accepting new patients
South Sound Inpatient Physicians, PLLC CurrentSince Apr 2, 2024 Accepting new patients
Whidbey Island Public Hospital District Past Accepting new patients

Locations

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

407 14th Ave SE
Puyallup, WA 98372
Phone (253) 697-4000

Organizations & group practices 4

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.

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": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1689340515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 DAVIS RD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386719635",
            "telephone_number": "901-428-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N MAIN ST",
            "city": "COUPEVILLE",
            "state": "WA",
            "postal_code": "98239",
            "telephone_number": "360-678-5151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 W Ravine Rd",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376603837",
            "country_code": "US",
            "telephone_number": "423-224-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "DNP, NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61540212",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "29874",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "WA",
            "license": "AP61540212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coupeville, WA

Sources for this page

Verify at the official NPI Registry.