MEDICARE: KRISTEN WILLIS JOSEPH NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN209178	GA

General Provider Information

NPI Number	:	1477904308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN WILLIS JOSEPH NP-C

Provider Business Mailing Address
First Line	:	128 ATO RD SE
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-7861
Country	:	US
Telephone Number	:	706-473-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 OPTUM CIR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2956
Country	:	US
Telephone Number	:	478-234-8011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	03/05/2026

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