Provider Demographics
NPI:1194447474
Name:TINSLEY, REBECCA MIKEL (PMHNP, DNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:MIKEL
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:PMHNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OLSON RD
Mailing Address - Street 2:
Mailing Address - City:ALADDIN
Mailing Address - State:WY
Mailing Address - Zip Code:82710-9707
Mailing Address - Country:US
Mailing Address - Phone:307-290-2606
Mailing Address - Fax:
Practice Address - Street 1:113 S. WEST ST.
Practice Address - Street 2:SUITE A
Practice Address - City:SUNDANCE
Practice Address - State:WY
Practice Address - Zip Code:82729-9998
Practice Address - Country:US
Practice Address - Phone:307-363-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY31210163WP0808X
WY54579363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health