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NPI Code Detail

MEDICARE: KRISTEN BLANCHE TALTY MCLEROY PA

MEDICARE: KRISTEN BLANCHE TALTY MCLEROY PA
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
1363A00000XPhysician Assistant0010-14512NC

General Provider Information

NPI Number : 1487493912
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN BLANCHE TALTY MCLEROY PA
Provider Business Mailing Address
First Line : 2330 WESTFIELD AVE
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27103-3643
Country : US
Telephone Number : 757-692-0257
Fax Number :
Provider Business Practice Location Address
First Line : 2020 N PEACE HAVEN RD
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-4851
Country : US
Telephone Number : 336-768-1280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2024
Last Update Date : 09/26/2024

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