Healthcare Provider Details

I. General information

NPI: 1821661802
Provider Name (Legal Business Name): QUE'LINDA LADAWN TILLMAN-WILSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WHITE OAK DR
CONWAY AR
72034-3444
US

IV. Provider business mailing address

10 WHITE OAK DR
CONWAY AR
72034-3444
US

V. Phone/Fax

Practice location:
  • Phone: 501-232-3101
  • Fax:
Mailing address:
  • Phone: 501-232-3101
  • Fax: 615-523-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number216880
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR100218
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number79277
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: