Tisa Marie Williams, in Louisville, KY - Medicare Nurse Practitioner

Tisa Marie Williams, is a medicare enrolled "Nurse Practitioner - Gerontology" in Louisville, Kentucky. She graduated from nursing school in 2022 and has 3 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Kettering Independent Medical Group Inc and her current practice location is 3999 Dutchmans Ln Ste 7b, Louisville, Kentucky. You can reach out to her office (for appointments etc.) via phone at (502) 896-4791.

Tisa Marie Williams is licensed to practice in Kentucky (license number 4036265) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1649964107.

Contact Information

	Tisa Marie Williams,
	3999 Dutchmans Ln Ste 7b, Louisville, KY 40207-4742
	(502) 896-4791
	Not Available

Map and Direction

Provider's Profile

Full Name	Tisa Marie Williams
Gender	Female
Speciality	Nurse Practitioner
Experience	3 Years
Location	3999 Dutchmans Ln Ste 7b, Louisville, Kentucky
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Tisa Marie Williams graduated from nursing school in 2022

NPI Data:

NPI Number: 1649964107
Provider Enumeration Date: 06/07/2023
Last Update Date: 08/26/2025

Medicare PECOS Information:

PECOS PAC ID: 6709224322
Enrollment ID: I20240402002238

Medical Identifiers

Medical identifiers for Tisa Marie Williams such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1649964107	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LG0600X	Nurse Practitioner - Gerontology	APRN.CNP.0033951 (Ohio)	Secondary
363LG0600X	Nurse Practitioner - Gerontology	4036265 (Kentucky)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Kettering Medical Center	Kettering, OH	Hospital
Soin Medical Center	Beaver creek, OH	Hospital
Fort Hamilton Hughes Memorial Hospital	Hamilton, OH	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Kettering Independent Medical Group Inc	3173710936	602

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Tisa Marie Williams allows following entities to bill medicare on her behalf.

Entity Name	Kettering Independent Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1629387865 PECOS PAC ID: 3173710936 Enrollment ID: O20101207000425

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tisa Marie Williams is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Tisa Marie Williams, Po Box 776351, Chicago, IL 60677-6351 Ph: (502) 559-9425	Tisa Marie Williams, 3999 Dutchmans Ln Ste 7b, Louisville, KY 40207-4742 Ph: (502) 896-4791

Reviews and Comments

Nurse Practitioner Nurses in Louisville, KY

Jacob William Harvey Jr., APRN-FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 516 W Breckinridge St, Louisville, KY 40203 Phone: 502-648-7909
Harold Dean O'brien, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1357 Bardstown Rd, Louisville, KY 40204 Phone: 502-897-6443 Fax: 502-897-3461
Tricia L. Flake, ARNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 4402 Churchman Ave, Suite 410, Louisville, KY 40215 Phone: 502-367-6322 Fax: 502-380-3843
Aimee Christine Mihalyov, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 10798 Dixie Hwy Ste 102, Louisville, KY 40272 Phone: 502-449-6464 Fax: 502-449-6465
Amanda Danielle Saccone, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1930 Bishop Ln Fl 12, Louisville, KY 40218 Phone: 502-272-5220 Fax: 502-272-5117
Celaida Lezcano, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 234 E Gray St Ste 670, Louisville, KY 40202 Phone: 502-629-4525 Fax: 502-629-4529
Victoria Jean Shipman, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 315 E Broadway Fl 4, Louisville, KY 40202 Phone: 502-629-2500

Tisa Marie Williams, - Medicare Nurse Practitioner in Louisville, KY