Type 1 · Individual ✓ Active NPI ✓ Valid NPI checksum
Jack K Willis Jr., PA
Physician Assistant in Odessa, TX · enumerated 2008.
Data current as of Jul 13, 2026 · sourced from CMS NPPES
National Provider Identifier
1063664183
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Registry record
Entity type Individual (Type 1)
Name Jack K Willis Jr.
Credential PA
Sex Male
Practice address 4060 Medical Park Dr # A, Odessa, TX, 79765
Phone (432) 582-2882
Fax (432) 582-2884
Enumeration date Oct 21, 2008
Last updated in NPPES Dec 12, 2025
Taxonomy & licenses
363A00000X Physician Assistant Physician Assistants & Advanced Practice Nursing Providers · License PA05950 (TX) Primary
PA · Physician Assistant: A licensed clinician who practices medicine in collaboration with physicians, trained in a graduate PA program.
About the PA credential
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.
Frequently asked questions
Where does Jack Willis practice?
The practice location on file with NPPES is in Odessa, TX. Providers can have multiple locations; NPPES lists the primary practice address.
What is the NPI number for Jack Willis?
The National Provider Identifier (NPI) for Jack Willis is 1063664183, a Type 1 (individual) record in the CMS NPPES registry.
Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-12-12.