MEDICARE: KORRIE LOUISE WILLSON FNP-BC

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	4704297735	MI

General Provider Information

NPI Number	:	1962106096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORRIE LOUISE WILLSON FNP-BC

Provider Business Mailing Address
First Line	:	4497 SHEFFIELD PL
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2554
Country	:	US
Telephone Number	:	989-894-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4497 SHEFFIELD PL
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-2554
Country	:	US
Telephone Number	:	989-894-8400
Fax Number	:

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

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	01/27/2026

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