Healthcare Provider Details

I. General information

NPI: 1306461660
Provider Name (Legal Business Name): BRENDA LYNN WILLIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 S 10TH ST
LEESVILLE LA
71446-4613
US

IV. Provider business mailing address

7946 HIGHWAY 10
PITKIN LA
70656-4567
US

V. Phone/Fax

Practice location:
  • Phone: 337-239-2207
  • Fax: 337-239-2583
Mailing address:
  • Phone: 337-208-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213832
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: