Brenda L Willis, MA, BSE

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

121 Commercial Dr # B
Stuttgart, AR 72160-7033

Phone

(870) 673-1633

Fax

(870) 673-1253

NPI assigned

Feb 21, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Locations

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.

• Southeast Arkansas Behavioral Healthcare System Inc

  • Community/Behavioral Health Agency
  • Pine Bluff, AR
  • NPI 1457398547
  NPD
• Southeast Arkansas Behavioral Healthcare System Inc

  • Community/Behavioral Health Agency
  • Stuttgart, AR
  • NPI 1730334798
  NPD (past)

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1770618928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RIKE DR",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716033937",
            "telephone_number": "870-534-1834",
            "fax_number": "870-534-5798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 COMMERCIAL DR # B",
            "city": "STUTTGART",
            "state": "AR",
            "postal_code": "721607033",
            "telephone_number": "870-673-1633",
            "fax_number": "870-673-1253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 Rike Dr",
            "address_purpose": "LOCATION",
            "city": "Pine Bluff",
            "state": "AR",
            "postal_code": "716033937",
            "country_code": "US",
            "telephone_number": "870-534-1834",
            "fax_number": "870-534-5798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "BRENDA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "MA, BSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172242795",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Ann Vose, MS CCC-SLP
• Walmart Inc.
• David Lynn Wassell, MD
• Evelyn Webb, LCSW
• William a Fielder, OD, PA
• Dennis B Yelvington, M.D.
• Jewel Young

• Case Manager/Care Coordinator in Stuttgart, AR
• Providers in Stuttgart, AR by specialty
• Case Manager/Care Coordinator in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.