MEDICARE: QUE'LINDA LADAWN TILLMAN-WILSON PMHNP

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	216880	AR
2	163W00000X	Registered Nurse	R100218	AR
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	79277	ID

General Provider Information

NPI Number	:	1821661802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUE'LINDA LADAWN TILLMAN-WILSON PMHNP

Provider Business Mailing Address
First Line	:	10 WHITE OAK DR
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3444
Country	:	US
Telephone Number	:	501-232-3101
Fax Number	:	615-523-1730

Provider Business Practice Location Address
First Line	:	10 WHITE OAK DR
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-3444
Country	:	US
Telephone Number	:	501-232-3101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	12/22/2025

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