Provider Demographics
NPI:1245386762
Name:WILLS, CORINNE ROSE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CORINNE
Middle Name:ROSE
Last Name:WILLS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:ROSE
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3420 S 74TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5026
Mailing Address - Country:US
Mailing Address - Phone:479-573-3740
Mailing Address - Fax:479-573-3741
Practice Address - Street 1:3420 S 74TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5026
Practice Address - Country:US
Practice Address - Phone:479-573-3740
Practice Address - Fax:479-573-3741
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0074165363LF0000X
ARA003876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKR0074165OtherNURSING LICENSE
ARMH1050070OtherDEA
OKR0074165OtherNURSING LICENSE
OKR0074165OtherNURSING LICENSE