Healthcare Provider Details

I. General information

NPI: 1376190652
Provider Name (Legal Business Name): HEATHER EMILY WILLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 AUTUMN ACRES RD
BERKELEY SPRINGS WV
25411-3202
US

IV. Provider business mailing address

456 AUTUMN ACRES RD
BERKELEY SPRINGS WV
25411-3202
US

V. Phone/Fax

Practice location:
  • Phone: 304-258-3673
  • Fax: 304-258-0017
Mailing address:
  • Phone: 304-258-3673
  • Fax: 304-258-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN64452NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: