Healthcare Provider Details

I. General information

NPI: 1023588308
Provider Name (Legal Business Name): WILLIS EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 17TH STREET
BAKERSFIELD CA
93301
US

IV. Provider business mailing address

1031 17TH STREET
BAKERSFIELD CA
93301
US

V. Phone/Fax

Practice location:
  • Phone: 661-234-9894
  • Fax: 661-360-6243
Mailing address:
  • Phone: 661-234-9894
  • Fax: 661-360-6243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: JENICA WILLIS
Title or Position: OWNER
Credential: LM, CPM, LVN, IBCLC
Phone: 661-330-0084