Provider Demographics
NPI:1407610983
Name:WILLEY, JEFFREY ALLAN (PHD, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLAN
Last Name:WILLEY
Suffix:
Gender:M
Credentials:PHD, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 WOODLAND FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-4650
Mailing Address - Country:US
Mailing Address - Phone:302-841-9990
Mailing Address - Fax:
Practice Address - Street 1:4049 WOODLAND FERRY RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-4650
Practice Address - Country:US
Practice Address - Phone:302-841-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010574363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health