Provider Demographics
NPI:1598298176
Name:WILLIS, CHELSEA DAWN (DO)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:DAWN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KS
Mailing Address - Zip Code:66097-4003
Mailing Address - Country:US
Mailing Address - Phone:844-536-9449
Mailing Address - Fax:844-845-9082
Practice Address - Street 1:408 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KS
Practice Address - Zip Code:66097-4003
Practice Address - Country:US
Practice Address - Phone:844-536-9449
Practice Address - Fax:844-845-9082
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0542913207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine