MEDICARE: KENNYON GLENN WILLIS

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1891130688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNYON GLENN WILLIS

Provider Business Mailing Address
First Line	:	1209 W HEFNER RD
Second Line	:	APT 162
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-7007
Country	:	US
Telephone Number	:	405-305-9476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 W HEFNER RD
Second Line	:	APT 162
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73114-7007
Country	:	US
Telephone Number	:	405-305-9476
Fax Number	:

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

Provider Enumeration Date	:	05/07/2013
Last Update Date	:	05/07/2013

Similar Medicare Providers

1023404456 — SHAYLA TAYLOR
Practice Location Address:

1209 W HEFNER RD , 160
OKLAHOMA CITY, OK
73114-7007

Practice Phone: 580-230-1583
Practice Fax:

1124156153 — BELLECARE INC.
Practice Location Address:

2801 NW 61ST ST
OKLAHOMA CITY, OK
73112-7007

Practice Phone: 405-842-6601
Practice Fax: 405-810-8482

1326343419 — RECEIVER CARE LLC
Practice Location Address:

2801 NW 61ST ST
OKLAHOMA CITY, OK
73112-7007

Practice Phone: 405-842-6601
Practice Fax: 405-810-8482

1376827360 — LACONDA WALTER
Practice Location Address:

1805 NE 52ND ST
OKLAHOMA CITY, OK
73111-7007

Practice Phone: 816-304-4924
Practice Fax:

1548544539 — DEANDRE WALTER
Practice Location Address:

1805 NE 52ND ST
OKLAHOMA CITY, OK
73111-7007

Practice Phone: 405-255-2874
Practice Fax:

1508103763 — NW 61ST NURSING, LLC
Practice Location Address:

2801 NW 61ST ST
OKLAHOMA CITY, OK
73112-7007

Practice Phone: 405-842-6601
Practice Fax: 405-810-8482

Directions to “ KENNYON GLENN WILLIS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.