Provider Demographics
NPI:1740445287
Name:WILLIS, EMILY RUTH (CRNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RUTH
Last Name:WILLIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:RUTH
Other - Last Name:FLIGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 HUGHES RD STE 8
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8959
Mailing Address - Country:US
Mailing Address - Phone:704-451-1928
Mailing Address - Fax:
Practice Address - Street 1:540 HUGHES RD STE 8
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8959
Practice Address - Country:US
Practice Address - Phone:704-451-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN152509163W00000X
AZAP3047363LW0102X
AL1-124510363LW0102X
AL1124510363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse