Provider Demographics
NPI:1609407642
Name:WILLIS, JULIE D (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:WILLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 BALDWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-2010
Mailing Address - Country:US
Mailing Address - Phone:361-500-0096
Mailing Address - Fax:361-444-5153
Practice Address - Street 1:2120 BALDWIN BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2010
Practice Address - Country:US
Practice Address - Phone:361-500-0096
Practice Address - Fax:877-409-2521
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144716363LP0200X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP144716OtherFNP LICENSE NUMBER