DEIDRA WILLIS (NPI# 1114452901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114452901 |
| Entity Type | Individual |
| Full Name | DEIDRA WILLIS |
| Credential | A- GNP |
| Practice Address |
6439 Garners Ferry Rd Columbia SC 29209-1638 |
| Mailing Address |
160 Katrina Ct Lexington SC 29073-6924 |
| Practice Telephone | 8037764000 |
| Mailing Telephone | 8034138700 |
| Enumeration Date | 2017-04-29 |
| Last Update Date | 2017-04-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
20835 | SC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
6439 GARNERS FERRY RD |
| City | COLUMBIA |
| State | SC |
| Zip Code | 29209-1638 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720088149 | Bryan Davies | Podiatrist | 6439 Garners Ferry Rd, Columbia, SC 29209 | 2005-07-28 |
| 1255932901 | Juno Momoko Davenport | Social Worker | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-11-07 |
| 1144820275 | Heather Ruffin | Recreation Therapist | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-10-28 |
| 1881201317 | Danelle Alexis Magalit | Social Worker | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-09-29 |
| 1700493186 | Allison Marie Anderson | Audiologist | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-09-29 |
| 1346854783 | Sophia Armstrong | Social Worker | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-09-02 |
| 1609489756 | Jeani Rae Clark Quattlebaum | Social Worker | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-08-28 |
| 1851902340 | Brittany Franklin | Social Worker | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-08-10 |
| 1477162667 | Amee Shah | Pharmacist | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-07-24 |
| 1780292482 | Mary Catherine Chase Hess | Nurse Practitioner | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2020-07-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992293013 | Pertile Group LLC | Family Medicine | 26 Foot Point Rd, Columbia, SC 29209 | 2018-04-24 |
| 1083156061 | Derek Clark | Physical Therapist | 6349 Garners Ferry Rd, Columbia, SC 29209 | 2016-11-08 |
| 1922450345 | Heather Alexander | Social Worker | 6439 Garners-ferry Road, Suite 122, Wjb Dorn Va, Columbia, SC 29209 | 2016-07-09 |
| 1265888325 | Daphne Elaine Allen | Counselor | 1850 Pinview Dr, Columbia, SC 29209 | 2016-05-09 |
| 1659757649 | Marc Edmundson | Pharmacist | 500 Gills Creek Pkwy #810, Columbia, SC 29209 | 2015-08-03 |
| 1477949113 | Winter Years Home Health Care Agency, LLC | Home Health | 1101 1st Street, P, Columbia, SC 29209 | 2015-04-09 |
| 1285045773 | Alireza Adhami | Pharmacist | 7235 Garners Ferry Rd, Columbia, SC 29209 | 2014-05-19 |
| 1790039212 | Immediate Dental Group Columbia | Dentist | 1118 Greenlawn Drive, Columbia, SC 29209 | 2012-11-06 |
| 1275896284 | Tariq Horani | Internal Medicine | 6349 Garners Ferry Road, Int Med -, Columbia, SC 29209 | 2012-06-25 |
| 1902165467 | Medcare Urgent Care Center Garners Ferry, LLC | Clinic/Center | 7418 Garners Ferry Road, Columbia, SC 29209 | 2012-05-03 |
| Find all providers in zip 29209 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447851084 | Paris Gartmon | Nurse Practitioner | 630 Canalside St Unit 1016, Columbia, SC 29201-6030 | 2020-11-02 |
| 1780241182 | Adrienne Lendsey Hinton | Nurse Practitioner | 201 Lake Front Dr, Columbia, SC 29212-2422 | 2019-05-22 |
| 1114373651 | Lilian Emetu | Nurse Practitioner | 822 Statler Road, Columbia, SC 29210 | 2016-05-13 |
| 1720402753 | Jennifer M Newton | Nurse Practitioner | 795 Old Clemson Rd, Columbia, SC 29229-4203 | 2014-02-11 |
| 1437418258 | Bear Creek Medical Clinic | Nurse Practitioner | 156 Bear Creek Pike, 7 A, Columbia, TN 38401-2288 | 2012-05-14 |
| 1144828468 | Ivy Health Solutions LLC | Nurse Practitioner | 4100 N Main St Ste 201, Columbia, SC 29203-5800 | 2020-10-09 |
| 1932712627 | Porsha Canzater Moore | Nurse Practitioner | 5 Richland Medical Park Dr, Columbia, SC 29203-6863 | 2020-08-24 |
| 1053952457 | Evelynn Marie Pennington | Nurse Practitioner | 6439 Garners Ferry Rd, Columbia, SC 29209-1638 | 2019-10-07 |
| 1477901452 | Kathy Lynn Onwezen | Nurse Practitioner | 1605 E Broadway Ste 300, Columbia, MO 65201-8023 | 2016-05-31 |
| 1245685478 | Tiffany Johnson | Nurse Practitioner | 3010 Farrow Rd, Columbia, SC 29203-7607 | 2016-04-25 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.