Healthcare Provider Details

I. General information

NPI: 1306904412
Provider Name (Legal Business Name): REGINA RENEE WILLIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 SHED RD STE 500
BOSSIER CITY LA
71111-5587
US

IV. Provider business mailing address

5015 SHED RD
BOSSIER CITY LA
71111-5584
US

V. Phone/Fax

Practice location:
  • Phone: 318-741-5858
  • Fax: 318-741-4496
Mailing address:
  • Phone: 318-741-5858
  • Fax: 318-741-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP05016
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN054611
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAP05016
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: