Provider Demographics
NPI:1710691209
Name:WILLEY, JAIME HAMILTON (CRNP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:HAMILTON
Last Name:WILLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 SOMER BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-7120
Mailing Address - Country:US
Mailing Address - Phone:256-665-5696
Mailing Address - Fax:
Practice Address - Street 1:227 SOMER BRIDGE DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-7120
Practice Address - Country:US
Practice Address - Phone:256-665-5696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-104626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily