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

MS. Konneen Willis, PA

Individual provider Medical Physician Assistant · NPI 1861510240

MS. Konneen Willis, PA is a Physician Assistant in Bountiful, Utah. Qualified in 2004, 22 years ago. Practices with Canyon Ridge Pain and Spine PC, a 2-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
22
Licensed in
UT
In the registry since
2007
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1551 Renaissance Towne Dr Ste 460
Bountiful, UT 84010-7667
Phone: (801) 294-7246
Fax: (801) 294-2560
Show map & directions

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

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 107354-1206 (UT)

Record details

NPI number1861510240
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMarch 26, 2007
Last updated in NPPESFebruary 25, 2021
Certification dateFebruary 25, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Canyon Ridge Pain And Spine Pc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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