Carmen Renee Willis, NP-C
Individual provider Active NPI Family Nurse Practitioner · Cushing, TX
NPI 1861979734 · NPPES record last updated Jul 24, 2018
Key facts
- NPI
- 1861979734
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP138180 (TX)
- Practice address
- 495 County Road 971
Cushing, TX 75760-3734 - Phone
- (936) 652-3870
- NPI assigned
- Jul 24, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of Texas Southwestern Medical School at Dallas, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Oliver Street 5.01(a) Inc
Practice addresses (Care Compare)
1105 W Frank Ave
Suite 320
Lufkin, TX 75904-3302
Phone (936) 585-7770
Hospital & facility affiliations
- Nacogdoches Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190226000673 | TX | Practitioner - Nurse Practitioner | 7517206196 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP138180 | TX | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midsouth Homecare PLLC | Family | Current |
Accepting new patients |
| Wholistic Imaging LLC | Current |
Accepting new patients | |
| Wholistic Wound Care & Wellness PLLC | Family | Current |
Accepting new patients |
| Oliver Street 5.01(a) Inc. | Current |
Accepting new patients | |
| Midsouth Transitions Medical Group | Family | Current |
Accepting new patients |
| BHS Specialty Network Inc | Past |
Accepting new patients |
Locations
3808 N University Dr
Nacogdoches, TX 75965
Phone (936) 585-7700
24165 Ih 10 W
Ste 217807
San Antonio, TX 78257
5904 Summerfield Dr
Texarkana, TX 75503
Phone (430) 200-4350
Interoperability endpoints
- https://api.platform.athenahealth.com/18412/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP138180 | TX | Yes |
Addresses
Primary practice location
495 County Road 971
Cushing, TX 75760-3734
Mailing address
495 County Road 971
Cushing, TX 75760-3734
Other providers in Cushing, TX
All providers in Cushing, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.