Active NPI
Kyle Willis, PHARMD
- Pharmacist
- Texarkana, TX
National Provider Identifier
1851751374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 52694
- Practice address
- 4315 Texas Blvd
Texarkana, TX 75503-3024 - Phone
- (877) 354-2688
- NPI assigned
- Feb 25, 2016
- Last updated
- Feb 25, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 52694 | TX | Primary |
Addresses
Primary practice location
4315 Texas Blvd
Texarkana, TX 75503-3024
Mailing address
5 Birchwood Cir
Texarkana, TX 75503-0569
Phone (501) 733-5797
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52694 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reliant Medical LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1456358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456358400000",
"number": "1851751374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 BIRCHWOOD CIR",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755030569",
"telephone_number": "501-733-5797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4315 TEXAS BLVD",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755033024",
"telephone_number": "877-354-2688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIS",
"first_name": "KYLE",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-02-25",
"last_updated": "2016-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "52694",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.