Gloria E Willoughby, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

651038 Issued in TX

Practice address

150 Pine Forest Dr
Suite 110
Shenandoah, TX 77384-5302

Phone

(281) 709-2555

Fax

(281) 440-9915

NPI assigned

May 19, 2006

Last updated

Aug 26, 2016By the provider in NPPES

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 4

Medicare fee-for-service enrollment

Enrolled in TX

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

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Calvary Medical, PA

  dba Calvary Medical Clinic

  • Legal Medicine
  • Cleveland, TX
  • NPI 1265568042
  Medicare reassignment NPD
• Geriatric & Palliative Care Associates,PA

  • Geriatric Medicine (Family Medicine) Physician
  • Shenandoah, TX
  • NPI 1770038549
  Medicare reassignment NPD

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472169600000",
    "number": "1831143627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 PINE FOREST DR",
            "address_2": "SUITE F",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773845302",
            "telephone_number": "281-709-2555",
            "fax_number": "281-440-9915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 PINE FOREST DR",
            "address_2": "SUITE 110",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773845302",
            "telephone_number": "281-709-2555",
            "fax_number": "281-440-9915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLOUGHBY",
        "first_name": "GLORIA",
        "middle_name": "E",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2016-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "651038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187619502",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187619501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152611301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152611302",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mitchell William, PT, DPT
• Jocelyn Williams
• Zachary Marshall Williams, FNP-C
• Sarah Willis
• Rylan Willkens, DNP, AGACNP-BC
• Alana Nicole Wilson, PA-C
• Alexia Wilson
• Garret Lee Wilson, PT, DPT
• Leslie E Wilson, M.D.
• Tyra Michelle Wilson, PA

• Family Nurse Practitioner in Shenandoah, TX
• Providers in Shenandoah, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; 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.