Monte Revell Willis

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

425 W 19TH St Ste D&E
Panama City, FL 32405-4659

Phone

(850) 818-0220

Fax

(850) 818-0156

NPI assigned

Jun 3, 2024

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 names 1

• Monte Revell Former name

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Associates of Tallahassee PAGroup PAC ID 6608775499, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Dermatology Associates of Tallahassee PA

  • Dermatology Physician
  • Tallahassee, FL
  • NPI 1295842672
  Medicare reassignment Care Compare group
• Dermatology Associates of Tallahassee, PA

  • Dermatology Physician
  • Valdosta, GA
  • NPI 1730567504
  NPD

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

{
    "created_epoch": "1717372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779840000000",
    "number": "1780425892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13834",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323173834",
            "telephone_number": "850-205-6232",
            "fax_number": "855-975-0615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W 19TH ST STE D&E",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054659",
            "telephone_number": "850-818-0220",
            "fax_number": "850-818-0156"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1704 Riggins Rd",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323085318",
            "country_code": "US",
            "telephone_number": "850-877-4134",
            "fax_number": "850-942-4112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "MONTE",
        "middle_name": "REVELL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-03",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MONTE",
            "last_name": "REVELL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tia M. Williams, MSW, RCSWI
• Twyla Williams
• Thomas Carl Williamson, A.R.N.P.
• Christopher L Willingham, M.D.
• Kirsti F Willis, RN, RNFA
• Terrie Willis, OT
• Willowdean D. Tiller, Inc.
• Cynthia Leigh Wilson, PSYD
• Felicia Loe Wilson, LMHC
• Glenda F Wilson, PT

• Physician Assistant in Panama City, FL
• Providers in Panama City, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.