Willie Earl Sallis, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

301 Andrews Ave
Lyster Army Health Clinic Blding
Fort Rucker, AL 36362-0701

Phone

(334) 255-7349

NPI assigned

Jul 7, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1689606709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 ANDREWS AVE",
            "address_2": "LYSTER ARMY HEALTH CLINIC BLDING",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "363620701",
            "telephone_number": "334-255-7349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 ANDREWS AVE",
            "address_2": "LYSTER ARMY HEALTH CLINIC BLDING",
            "city": "FORT RUCKER",
            "state": "AL",
            "postal_code": "363620701",
            "telephone_number": "334-255-7349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLIS",
        "first_name": "WILLIE",
        "middle_name": "EARL",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Ruminski, D.O.
• Angus H Rupert, M.D.
• Maxiene H Ryan, LPN
• Robert Corey Rymer, NREMT
• Amos Samuel Salas, NREMT-BASIC
• Scott A Salmon, MD, MPH
• Tiffany Monique Samuels, EMT-B/ HEALTHCARE SP
• Dorma Sanders, RN
• Omar Saucedo, EMT/HEALTHCARE SPC
• Mason Webb Sauerwein

• Physician Assistant in Fort Rucker, AL
• Providers in Fort Rucker, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.