Provider Demographics
NPI:1215652789
Name:WILLEY, JESSIE ELLEN (NP)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:ELLEN
Last Name:WILLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9077 MAY APPLE LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-6810
Mailing Address - Country:US
Mailing Address - Phone:443-880-8998
Mailing Address - Fax:
Practice Address - Street 1:503 CYNWOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3869
Practice Address - Country:US
Practice Address - Phone:443-786-1113
Practice Address - Fax:800-603-4290
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR215048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty