Healthcare Provider Details

I. General information

NPI: 1548198385
Provider Name (Legal Business Name): WILD WITHIN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W HAVENS AVE
MITCHELL SD
57301-4334
US

IV. Provider business mailing address

515 W HAVENS AVE
MITCHELL SD
57301-4334
US

V. Phone/Fax

Practice location:
  • Phone: 605-553-1701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR ROBERTS
Title or Position: PMHNP-CNP
Credential: PMHNP-CNP
Phone: 605-553-1701