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General NPI Number Information
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NPI Number | 1871415182
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Entity Type | Individual
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Provider Name | KENDALL WILLIS FNP
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Gender | Female
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Dates
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Enumeration Date | 07/28/2026
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 1260 METROPOLITAN BLVD STE 302
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City | TALLAHASSEE
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State | FL
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Zip | 32312-2536
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Country | US
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Telephone | 850-216-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 198 POST OAK CIR
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City | MONTICELLO
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State | FL
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Zip | 32344-6794
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Country | US
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Telephone | 850-868-0811
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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 | 11049292
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License Number State | FL
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