First Light Lifestyle Medical Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FIRST LIGHT LIFESTYLE MEDICAL CLINIC PLLC

Practice address

30 7TH St W Ste LL-50
Dickinson, ND 58601-4335

Phone

(701) 483-6974

NPI assigned

Oct 12, 2022

Last updated

Oct 12, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Volney Willett, MDNPI 1912964966

Title

President

Phone

(701) 483-6974

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Volney L Willett III, M.D.

  • Family Medicine Physician
  • Dickinson, ND
  • NPI 1912964966
  Authorized official Same address or phone

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

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1801512819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 7TH ST W STE LL-50",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586014335",
            "telephone_number": "701-483-6974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 7TH ST W STE LL-50",
            "city": "DICKINSON",
            "state": "ND",
            "postal_code": "586014335",
            "telephone_number": "701-483-6974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST LIGHT LIFESTYLE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "WILLETT",
        "authorized_official_first_name": "VOLNEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-483-6974",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Dickinson, ND
• Providers in Dickinson, ND by specialty
• Family Medicine Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; 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.