MEDICARE: CHASE KYLEN WILLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1679429013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE KYLEN WILLIS

Provider Business Mailing Address
First Line	:	2800 YOUREE DR STE 120A
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3667
Country	:	US
Telephone Number	:
Fax Number	:	318-483-6137

Provider Business Practice Location Address
First Line	:	2800 YOUREE DR STE 120A
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-3667
Country	:	US
Telephone Number	:	318-562-3707
Fax Number	:	318-483-6137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ CHASE KYLEN WILLIS ” Practice Location

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