Provider Demographics
NPI:1396293833
Name:WILLIS, JESSICA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BUTLER FARM RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1777
Mailing Address - Country:US
Mailing Address - Phone:757-251-7469
Mailing Address - Fax:757-251-7470
Practice Address - Street 1:501 BUTLER FARM RD
Practice Address - Street 2:SUITE I
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1777
Practice Address - Country:US
Practice Address - Phone:757-251-7469
Practice Address - Fax:757-251-7470
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily