MEDICARE: TILLMAN PSYCHIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1578454518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TILLMAN PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	10 WHITE OAK DR
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3444
Country	:	US
Telephone Number	:	501-470-8265
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 WHITE OAK DR
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3444
Country	:	US
Telephone Number	:	501-470-8265
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PMHNP
Name	:	QUELINDA TILLMAN-WILSON
Credential	:
Telephone Number	:	501-470-8265

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	07/09/2025

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