Healthcare Provider Details

I. General information

NPI: 1457723389
Provider Name (Legal Business Name): BRIANNE WILLIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 JACKSON AVE
POINT PLEASANT WV
25550-1698
US

IV. Provider business mailing address

90 JACKSON PIKE
GALLIPOLIS OH
45631-1562
US

V. Phone/Fax

Practice location:
  • Phone: 304-674-4498
  • Fax: 304-675-2103
Mailing address:
  • Phone: 855-446-5937
  • Fax: 740-441-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.18269
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRNCNP105559
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: