Healthcare Provider Details

I. General information

NPI: 1194447474
Provider Name (Legal Business Name): REBECCA MIKEL TINSLEY CNP, DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S. WEST ST. SUITE A
SUNDANCE WY
82729-9998
US

IV. Provider business mailing address

19 OLSON RD
ALADDIN WY
82710-9707
US

V. Phone/Fax

Practice location:
  • Phone: 307-363-6163
  • Fax:
Mailing address:
  • Phone: 307-290-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number31210
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCP003450
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number54579
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: