IndividualActive
Jeramy Willis, KCSA
NPI 1780867473 · Surgical Physician Assistant · Bowling Green, KY
Provider details
- NPI number
- 1780867473
- Entity type
- Individual
- Primary specialty
- Surgical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- KCSA
- Sex
- Male
- Sole proprietor
- No
- License
- SA164 (KY)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1945 Scottsville Rd
B2 Pmb 397
Bowling Green, KY 42104-3376
Phone: (270) 781-4828
Fax: (270) 781-4828
Approximate (ZIP-level) locationGet directions
Mailing address
1945 Scottsville Rd. B2 Pmb 397
Bowling Green, KY 42104
Registry dates
- Enumerated
- 2007-12-17
- Last updated
- 2007-12-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.