Basic Information
| Provider Information | |||||||||
| NPI: | 1598298176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIS | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | DAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6675 HOLMES RD STE 360 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641311167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162767600 | ||||||||
| FaxNumber: | 8162767992 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 WOODFIELD DR | ||||||||
| Address2: | |||||||||
| City: | TONGANOXIE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660865443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138458400 | ||||||||
| FaxNumber: | 7855055272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2017 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 0542913 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.