Jaime Hamilton Willey, CRNP
Individual provider Active NPI Family Nurse Practitioner · Ardmore, TN
NPI 1710691209 · NPPES record last updated Oct 15, 2025
Key facts
- NPI
- 1710691209
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 1-104626 (AL)
- Practice address
- 26889 Main St
Ardmore, TN 38449-3151 - Phone
- (256) 665-5696
- Fax
- (256) 484-4389
- NPI assigned
- Jan 9, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231011003497 | AL | Practitioner - Nurse Practitioner | 5698120624 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-104626 | AL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MCMD LLC | Current |
Accepting new patients |
Locations
22292 US Highway 72
Athens, AL 35613
Phone (256) 230-6994
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1-104626 | AL | Yes |
Addresses
Primary practice location
26889 Main St
Ardmore, TN 38449-3151
Mailing address
26889 Main St
Ardmore, TN 38449-3151
Phone (256) 742-2555
Other providers in Ardmore, TN
- Vaughan Family Dentistry, PC
- Matthew Robert Vaughan
- Deborah Ruth Verbeek
- Wenric, Inc
- Dalton Emerson West
- Marlee Wright
All providers in Ardmore, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.