Provider Demographics
NPI:1811449614
Name:WILLIS, LEAH MICHELLE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:MICHELLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N AVENUE J
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-2100
Mailing Address - Country:US
Mailing Address - Phone:325-823-3200
Mailing Address - Fax:
Practice Address - Street 1:101 AVENUE J
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:TX
Practice Address - Zip Code:79501-2113
Practice Address - Country:US
Practice Address - Phone:325-823-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132090363LF0000X, 282NR1301X
TXAPI32090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No282NR1301XHospitalsGeneral Acute Care HospitalRural