1427065630 NPI number — MS. DIANNE KAY WILLS CRNP

Table of content: MS. DIANNE KAY WILLS CRNP (NPI 1427065630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427065630 NPI number — MS. DIANNE KAY WILLS CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLS
Provider First Name:
DIANNE
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427065630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 BROWN SPRINGS ROAD
Provider Second Line Business Mailing Address:
ATTN: PROVIDER ENROLLMENT
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-7005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-273-4508
Provider Business Mailing Address Fax Number:
334-273-4290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2105 EAST SOUTH BOULEVARD
Provider Second Line Business Practice Location Address:
ATTN; PALLIATIVE CARE
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-286-2987
Provider Business Practice Location Address Fax Number:
334-286-3368
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  1-041345 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051000325 . This is a "BC SOUTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051525630 . This is a "BC PRATTVILLE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891009010 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051525631 . This is a "BC EAST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891008990 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891008780 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com