Willie Sly, PMHNP-BC
Nurse Practitioner, Psych/Mental Health in Santa Rosa, CA. Individual provider (NPI-1).
NPI number1053166199
StatusActive
Last updated in NPPESMay 5, 2026
Details
- NPI
- 1053166199
- Entity type
- Individual (NPI-1)
- Name
- Willie Sly
- Credential
- PMHNP-BC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 22, 2024
- Certification date
- May 5, 2026
- Last updated
- May 5, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 95038910 | CA | Yes |
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 5971891 | ID |
Practice location
2448 Guerneville Rd Ste 800Santa Rosa, CA 95403-7228
Phone 707-772-7522
Mailing address
2448 Guerneville Rd Ste 800Santa Rosa, CA 95403-7228
Phone 707-772-7522
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All 36 Psychiatric/Mental Health Nurse Practitioner providers in Santa Rosa · All 8,142 providers in Santa Rosa
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