Healthcare Provider Details

I. General information

NPI: 1790602225
Provider Name (Legal Business Name): JENNIFER TINSLEY PMHNP-BC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S MAIN ST
DIETERICH IL
62424-1128
US

IV. Provider business mailing address

261 LEVI RD
LOUISVILLE IL
62858-2784
US

V. Phone/Fax

Practice location:
  • Phone: 618-629-7565
  • Fax: 618-822-4154
Mailing address:
  • Phone: 618-629-7565
  • Fax: 618-822-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JUSTINE TINSLEY
Title or Position: PMHNP-BC
Credential: APRN
Phone: 618-335-8740