Healthcare Provider Details

I. General information

NPI: 1427824333
Provider Name (Legal Business Name): JOSEPH TYLER SOTTILE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 S SHERIDAN AVE
SHERIDAN WY
82801-5644
US

IV. Provider business mailing address

1662 S SHERIDAN AVE
SHERIDAN WY
82801-5644
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-8941
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPT1173
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: