Healthcare Provider Details

I. General information

NPI: 1245395029
Provider Name (Legal Business Name): BARBARA FAY WILLIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 FOREST GROVE RD
HOMER LA
71040-7551
US

IV. Provider business mailing address

119 FOREST GROVE RD
HOMER LA
71040-7551
US

V. Phone/Fax

Practice location:
  • Phone: 337-718-2152
  • Fax:
Mailing address:
  • Phone: 337-718-2152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2020-0318
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD2020-0318
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: