Provider Demographics
NPI:1073027975
Name:WILLIS, TAMMI ARRANT (RN4)
Entity Type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:ARRANT
Last Name:WILLIS
Suffix:
Gender:F
Credentials:RN4
Other - Prefix:MS
Other - First Name:TAMMI
Other - Middle Name:JEANETTE
Other - Last Name:ARRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1023 NURSERY ST
Mailing Address - Street 2:
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-4832
Mailing Address - Country:US
Mailing Address - Phone:225-245-4950
Mailing Address - Fax:
Practice Address - Street 1:216 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4251
Practice Address - Country:US
Practice Address - Phone:337-463-4486
Practice Address - Fax:337-462-2486
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA104551163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health