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General NPI Number Information
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NPI Number | 1477904308
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Entity Type | Individual
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Provider Name | KRISTEN WILLIS JOSEPH NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 1 OPTUM CIR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-2956
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Country | US
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Telephone | 478-234-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 128 ATO RD SE
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-7861
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Country | US
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Telephone | 706-473-1875
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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 | RN209178
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License Number State | GA
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