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General NPI Number Information
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NPI Number | 1306461660
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Entity Type | Individual
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Provider Name | BRENDA LYNN WILLIS FNP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 919 S 10TH ST
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City | LEESVILLE
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State | LA
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Zip | 71446-4613
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Country | US
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Telephone | 337-239-2207
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Fax | 337-239-2583
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Provider Business Mailing Address
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Address Line | 7946 HIGHWAY 10
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City | PITKIN
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State | LA
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Zip | 70656-4567
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Country | US
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Telephone | 337-208-1680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 213832
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License Number State | LA
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