MEDICARE: MRS. CHARISSA HOLT WILLIS NP

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	APN0000008233	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760473649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARISSA HOLT WILLIS NP

Provider Business Mailing Address
First Line	:	1328 PAPERMILL POINTE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1903
Country	:	US
Telephone Number	:	865-212-0530
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 PAPERMILL POINTE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1903
Country	:	US
Telephone Number	:	865-212-0530
Fax Number	:

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	02/24/2025

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