Provider Demographics
NPI:1124306543
Name:WILLIS, JENNIFER (MS, MBA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MAIN STREET
Mailing Address - Street 2:UNIT 1407
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202
Mailing Address - Country:US
Mailing Address - Phone:214-800-2846
Mailing Address - Fax:214-853-5663
Practice Address - Street 1:6060 N CENTRAL EXPY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-5209
Practice Address - Country:US
Practice Address - Phone:214-927-6179
Practice Address - Fax:214-853-5663
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor