Provider Demographics
NPI:1841359692
Name:VILLARREAL, WILLIE M (DNP, FNP, MSN, RNFA)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:M
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:DNP, FNP, MSN, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 N LOOP 336 W STE 140-407
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3566
Mailing Address - Country:US
Mailing Address - Phone:936-524-7317
Mailing Address - Fax:936-788-5659
Practice Address - Street 1:2257 N LOOP 336 W STE 140-407
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3566
Practice Address - Country:US
Practice Address - Phone:936-524-7317
Practice Address - Fax:936-788-5659
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680131163WR0006X
TXAP129624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171733201Medicaid