TANYA WILLIS CNNP NPI 1306873732

NPI Information

NPI: 1306873732
Provider Name: TANYA WILLIS, CNNP
Classification: Nurse Practitioner - 363LN0000X
Entity Type: Individual

Specialization: Neonatal

PECOS Registration: Yes

Address:
2500 N STATE ST
JACKSON, MS
ZIP 39216
Phone: (601) 984-5260
Get Directions

Tanya Willis, CNNP is a neonatal nurse practitioner in Jackson, MS. Tanya Willis, CNNP NPI is 1306873732. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2500 N STATE ST
JACKSON, MS
ZIP 39216-500
Phone: (601) 984-5260

The NPI 1306873732 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/28/2006 and was last updated on 6/14/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LN0000X	Nurse Practitioner	Neonatal	R851015	MISSISSIPPI	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	07628760	MEDICAID	MISSISSIPPI
2	512I500389	MEDICARE PIN	MISSISSIPPI
3	302I509155	MEDICARE PIN	MISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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