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

Mr. Jeramy C. Willis, KCSA

Individual provider Surgical Physician Assistant · NPI 1780867473

Mr. Jeramy C. Willis, KCSA is a Surgical Physician Assistant in Bowling Green, Kentucky. Licensed in Kentucky. Registered with an NPI since 2007.

Licensed in
KY
In the registry since
2007

Practice location Address checks out

1945 Scottsville Rd B2 Pmb 397
Bowling Green, KY 42104-3376
Phone: (270) 781-4828
Fax: (270) 781-4828
Show map & directions

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

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence SA164 (KY)

Record details

NPI number1780867473
Entity typeIndividual (Type 1)
GenderMale
Credentials KCSA
Sole proprietorNo
NPI enumeratedDecember 17, 2007
Last updated in NPPESDecember 17, 2007
Mailing address1945 Scottsville Rd. B2 Pmb 397, Bowling Green, KY 42104

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