Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Willie Sly, PMHNP-BC

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1053166199

Willie Sly, PMHNP-BC is a Nurse Practitioner in Santa Rosa, California. Qualified in 2025, 1 year ago. Licensed in California and Idaho.

Years since qualifying
1
Licensed in
CA, ID
In the registry since
2024
Specialties on file
2
What do these letters mean?
PMHNP-BC — Psychiatric-Mental Health Nurse Practitioner, Board Certified
A board-certified psychiatric nurse practitioner.

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Practice location Address checks out

2448 Guerneville Rd Ste 800
Santa Rosa, CA 95403-7228
Phone: (707) 772-7522
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 95038910 (CA)
Psychiatric/Mental Health Nurse Practitioner Taxonomy 363LP0808X · Licence 5971891 (ID)

Record details

NPI number1053166199
Entity typeIndividual (Type 1)
GenderMale
Credentials PMHNP-BC
Sole proprietorNo
NPI enumeratedApril 22, 2024
Last updated in NPPESMay 5, 2026
Certification dateMay 5, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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