=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548198385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILD WITHIN, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2026
-----------------------------------------------------
Last Update Date | 05/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 W HAVENS AVE
-----------------------------------------------------
City | MITCHELL
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57301-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-553-1701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 W HAVENS AVE
-----------------------------------------------------
City | MITCHELL
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57301-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PMHNP-CNP
-----------------------------------------------------
Name | TAYLOR ROBERTS
-----------------------------------------------------
Credential | PMHNP-CNP
-----------------------------------------------------
Telephone | 605-553-1701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------