Provider Demographics
NPI:1649429119
Name:WILLIS, DAWNA J (FNP)
Entity type:Individual
Prefix:
First Name:DAWNA
Middle Name:J
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:PO BOX 750103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38175-0103
Mailing Address - Country:US
Mailing Address - Phone:901-676-6218
Mailing Address - Fax:901-425-9639
Practice Address - Street 1:2838 HICKORY HILL RD STE 29
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-2161
Practice Address - Country:US
Practice Address - Phone:901-676-6218
Practice Address - Fax:901-425-9639
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810629363LF0000X
TN7247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily