Tyler Trenton Wansley, DNP, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

211117 Issued in LA

Practice address

23515 US-190
Mandeville, LA 70448

Phone

(985) 626-6300

NPI assigned

Feb 18, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northlake Physicians GroupGroup PAC ID 9739457342, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northlake Physicians Group

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mandeville, LA
  • NPI 1154855781
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1962035964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23515 HIGHWAY 190",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704487334",
            "telephone_number": "985-626-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23515 US-190",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "70448",
            "telephone_number": "985-626-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANSLEY",
        "first_name": "TYLER",
        "middle_name": "TRENTON",
        "name_prefix": "Dr.",
        "credential": "DNP, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "LA",
            "license": "211117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raymond Wallace III, LPN
• Shannon Walsdorf, PHD, MSW, LCSW
• Celeste Walther-Moran, LCSW
• Lesley Magner Wandler, LOTR
• Cristen Compagno Wandzilak, M.A., PLPC, NCC
• Alexandra Ward
• Bryan Scott Warner, MSW, RSW
• Conni Denise Warner, R.N.
• Fredric H Warren, MD
• April Washington, LPN

• Psychiatric/Mental Health Nurse Practitioner in Mandeville, LA
• Providers in Mandeville, LA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.