Provider Demographics
NPI:1962106096
Name:WILLSON, KORRIE LOUISE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KORRIE
Middle Name:LOUISE
Last Name:WILLSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KORRIE
Other - Middle Name:LOUISE
Other - Last Name:HORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4817 W PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2818
Mailing Address - Country:US
Mailing Address - Phone:989-667-6780
Mailing Address - Fax:
Practice Address - Street 1:4817 W PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2818
Practice Address - Country:US
Practice Address - Phone:989-667-6780
Practice Address - Fax:989-667-6218
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily