Individual provider · Type 1 NPI

Tisa Marie Williams

Gerontology Nurse Practitioner · Louisville, KY

NPI number 1649964107 Active

Practice location

3999 Dutchmans Ln Ste 7B
Louisville, KY 40207-4742

Mailing address

PO Box 776351
Chicago, IL 60677-6351

Other practice locations

  • 3315 Bexley Dr, Middletown, OH 45042-2570 · (937) 204-4043
  • 3700 Southern Blvd Ste 300, Kettering, OH 45429-1265 · (937) 643-9299

Specialties and licenses

TaxonomyCodeLicense
Gerontology Nurse Practitioner 363LG0600XAPRN.CNP.0033951 (OH)
Gerontology Nurse Practitioner Primary 363LG0600X4036265 (KY)

Gerontology Nurse Practitioner: Definition to come...

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About NPI 1649964107

Tisa Marie Williams's National Provider Identifier is 1649964107, issued on Jun 7, 2023. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Louisville, KY. The record was last updated on Aug 26, 2025.