MARK WILLIS (NPI# 1154838886) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154838886 |
| Entity Type | Individual |
| Full Name | MARK WILLIS |
| Credential | FNP |
| Practice Address |
777 Hospital Way Pocatello ID 83201-5175 |
| Practice Telephone | 2082391000 |
| Mailing Telephone | 2082391000 |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2018-01-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
57490 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326136326 | Mark A Willis | Dentist | 5604 Ellsworth Rd, Fort Smith, AR 72903-3224 | 2006-10-11 |
| 1740269612 | Mark L Willis | Anesthesiology | 208 Haven Dr, Southeast Pain Mgmt Center, Dothan, AL 36301-2909 | 2006-01-10 |
| 1649423617 | Mark Willis | Otolaryngology | 12605 E 16th Ave, Aurora, CO 80045-2545 | 2008-11-03 |
| 1326137514 | Mark C Willis Jr. | Orthopaedic Surgery | 1250 E Marshall St, Orthopaedic Surgery, Richmond, VA 23298-0510 | 2006-10-12 |
| 1215965751 | Mark A Willis | Physical Therapist | 1514 Owens St, Gadsden, AL 35904-4938 | 2006-06-30 |
| Street Address |
777 HOSPITAL WAY |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-5175 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104825892 | Gregory S Harrison | Neurological Surgery | 777 Hospital Way, Suite 115, Pocatello, ID 83201-5175 | 2005-07-15 |
| 1801401344 | Sunny Blue Alene Nelson | Physician Assistant | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-09-11 |
| 1316570757 | Mark Alan Pendleton | Nurse Anesthetist, Certified Registered | 777 Hospital Way, Pocatello, ID 83201-5175 | 2020-02-13 |
| 1508413220 | Hilary Worthen | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-08-19 |
| 1437612447 | Walter S Medlin Md PC | Surgery | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-04-08 |
| 1396203428 | Amber Frost | Family Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2019-03-07 |
| 1649756404 | Kamilla Gundersen | Nurse Practitioner | 777 Hospital Way, Pocatello, ID 83207 | 2018-07-16 |
| 1043716285 | Brice Anderson | Specialist/Technologist | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-04-05 |
| 1851808133 | Rocky Mountain Physician Group LLC | Emergency Medicine | 777 Hospital Way, Pocatello, ID 83201-5175 | 2018-01-08 |
| 1588187892 | Rachel Goulart | Physician Assistant | 777 Hospital Way, Pocatello, ID 83201-5175 | 2017-07-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679183388 | Health Innovations, LLC | Nurse Practitioner | 240 N 18th Ave, Pocatello, ID 83201-3324 | 2020-08-06 |
| 1285295634 | Rebekah Lucero | Nurse Practitioner | 2185 Steven St, Pocatello, ID 83201-1928 | 2019-06-26 |
| 1285199869 | Jason Knighton | Nurse Practitioner | 5800 S 5th Ave, Pocatello, ID 83204-2205 | 2019-02-07 |
| 1356812945 | Dellisa Dawn Eddington | Nurse Practitioner | 6000 S 5th Ave, Pocatello, ID 83204-5075 | 2018-12-08 |
| 1457839730 | In Balance: Integrative Primary Healthcare Pllc | Nurse Practitioner | 1017 E Young St, Pocatello, ID 83201-5237 | 2018-07-30 |
| 1851885420 | Jordan Clay Chapman | Nurse Practitioner | 777 Hospital Way Ofc Bldg, Pocatello, ID 83201-2797 | 2018-06-18 |
| 1356846398 | Paul Haislip | Nurse Practitioner | 340 N 14th Ave, Pocatello, ID 83201-4118 | 2018-03-29 |
| 1568906865 | Dustin Reno | Nurse Practitioner | 1155 Yellowstone Ave Ste D, Pocatello, ID 83201-4369 | 2016-12-06 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1376992503 | Andrea Walsh | Nurse Practitioner | 1133 Call Creek Dr, Ste A, Pocatello, ID 83202 | 2016-06-08 |
| Find all providers in POCATELLO | ||||
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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.