Provider Demographics
NPI:1023567450
Name:WILLIS, KIRSTI F (RN, RNFA)
Entity Type:Individual
Prefix:
First Name:KIRSTI
Middle Name:F
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RN, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W CENTRAL TEXAS EXPY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2079
Mailing Address - Country:US
Mailing Address - Phone:254-618-4933
Mailing Address - Fax:254-618-1191
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:SUITE 604
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3661
Practice Address - Country:US
Practice Address - Phone:850-770-3030
Practice Address - Fax:850-770-3035
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9367661163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant