Jodi Willis

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Practice address

305 Wooley St
Raeford, NC 28376-3236

Phone

(910) 875-5074

Fax

(910) 875-7694

NPI assigned

Oct 30, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Hoke Co Association for Develop Disabled Inc.

  • Developmentally Disabled Services Day Training Agency
  • Raeford, NC
  • NPI 1265528632
  NPD (past) Authorized official

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193702400000",
    "number": "1912186792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 WOOLEY ST",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283763236",
            "telephone_number": "910-875-5074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 WOOLEY ST",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283763236",
            "telephone_number": "910-875-5074",
            "fax_number": "910-875-7694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JODI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-30",
        "last_updated": "2007-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300027K",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kris F Williams-Falcon, PHD, CPASTC, MSW,SAC
• Angela Susana Williams
• Anyha Achanty Williams
• Keyandre'a Nicole Williams
• Regine K Williams
• Willow Blossom Births, LLC
• Amanda Kaye Wilson
• Jennifer Lynnette Wilson, PA-C
• Rogina Wilson
• Dena Reay Winter, MSW, LCSWA

• Developmental Disabilities Clinic/Center in Raeford, NC
• Providers in Raeford, NC by specialty
• Developmental Disabilities Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; 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.