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General NPI Number Information
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NPI Number | 1972203438
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Entity Type | Individual
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Provider Name | NAKIAH WILLIS
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Gender | Female
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 5200 S BLACKWELDER AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73119-6226
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Country | US
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Telephone | 870-205-3188
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Fax | 405-587-4800
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Provider Business Mailing Address
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Address Line | PO BOX #563
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City | JENKS
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State | OK
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Zip | 74037
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Country | US
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Telephone | 918-694-0626
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SLPA421
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License Number State | OK
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