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NPI Code Detail

MEDICARE: CORRIE J WILLIS RNBC, APMHCNS

MEDICARE: CORRIE J WILLIS RNBC, APMHCNS
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner107534MO

General Provider Information

NPI Number : 1891771010
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORRIE J WILLIS RNBC, APMHCNS
Provider Business Mailing Address
First Line : 900 E LAHARPE ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-4520
Country : US
Telephone Number : 660-665-1962
Fax Number :
Provider Business Practice Location Address
First Line : 900 E LAHARPE ST
Second Line :
City : KIRKSVILLE
State : MO
Zip : 63501-4520
Country : US
Telephone Number : 660-665-1962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2005
Last Update Date : 09/19/2025

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