Provider Demographics
NPI:1417250580
Name:WILLEY, KERRY A (NP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:WILLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:A
Other - Last Name:TREACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 BELMONT ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2964
Mailing Address - Country:US
Mailing Address - Phone:508-770-1602
Mailing Address - Fax:508-770-1605
Practice Address - Street 1:116 BELMONT ST
Practice Address - Street 2:SUITE 12
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2964
Practice Address - Country:US
Practice Address - Phone:508-770-1602
Practice Address - Fax:508-770-1605
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily