Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Katelyn Rose Willis

Individual provider Family Nurse Practitioner · NPI 1003613316

Katelyn Rose Willis is a Nurse Practitioner in Idaho Falls, Idaho. Qualified in 2024, 2 years ago. Practices with Community Care West Side LLC, a 17-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
2
Licensed in
ID
In the registry since
2025

Practice location Address checks out

3230 Nina Dr
Idaho Falls, ID 83404-7428
Phone: (208) 243-6077
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 4071550 (ID)

Record details

NPI number1003613316
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 26, 2025
Last updated in NPPESFebruary 26, 2025
Certification dateJanuary 30, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Community Care West Side Llc — 17 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Idaho Falls