Healthcare Provider Details

I. General information

NPI: 1982134557
Provider Name (Legal Business Name): JENNIFER J TINSLEY APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date: 02/01/2021
Reactivation Date: 03/18/2021

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: 618-335-8740
  • Fax: 618-822-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277.005212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: