# WILLIE SLY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1053166199
- **Gender:** Man
- **Credential:** PMHNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | 95334289 | CA | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 5971891 | ID | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 95038910 | CA | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 95334289 | CA | Yes |

## Other

- **Enumeration date:** 04/22/2024
- **Last updated:** 05/05/2026