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NPI Code Detail

MEDICARE: MRS. MICHELE LYNN WILLIS CPHT

MEDICARE: MRS. MICHELE LYNN WILLIS CPHT
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
1183700000XPharmacy Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1330953OTHERNABP

General Provider Information

NPI Number : 1699611699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELE LYNN WILLIS CPHT
Provider Business Mailing Address
First Line : 987 GARFIELD WAY
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37042-3375
Country : US
Telephone Number : 719-200-6531
Fax Number :
Provider Business Practice Location Address
First Line : 650 JOEL DR
Second Line :
City : FORT CAMPBELL
State : KY
Zip : 42223-8355
Country : US
Telephone Number : 270-461-2199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2026
Last Update Date : 04/24/2026

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