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

Tisa Marie Williams

Individual provider Gerontology Nurse Practitioner · NPI 1649964107

Tisa Marie Williams is a Nurse Practitioner in Louisville, Kentucky. Qualified in 2022, 4 years ago. Practices with Kettering Independent Medical Group Inc, a 700-clinician group, works from 3 locations, accepts Medicare assignment and offers telehealth. Licensed in Kentucky and Ohio.

Years since qualifying
4
Licensed in
KY, OH
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

3999 Dutchmans Ln Ste 7B
Louisville, KY 40207-4742
Phone: (502) 896-4791
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 3700 Southern Blvd Ste 300, Kettering, OH 45429-1265 — (937) 643-9299
  • 3315 Bexley Dr, Middletown, OH 45042-2570 — (937) 204-4043

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence 4036265 (KY)
Gerontology Nurse Practitioner Taxonomy 363LG0600X · Licence APRN.CNP.0033951 (OH)

Record details

NPI number1649964107
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJune 7, 2023
Last updated in NPPESAugust 26, 2025
Certification dateAugust 26, 2025

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Kettering Independent Medical Group Inc — 700 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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