Healthcare Provider Details

I. General information

NPI: 1285214742
Provider Name (Legal Business Name): JENNIFER L WILLISON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L MORGAN

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date: 04/22/2024
Reactivation Date: 05/10/2024

III. Provider practice location address

1050 DELAWARE AVE
MARION OH
43302-6416
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7950
  • Fax: 740-375-8164
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-140630
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: