Healthcare Provider Details

I. General information

NPI: 1295309342
Provider Name (Legal Business Name): TALITHA RUTH MOTON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 1005 BOX 11000
FPO AA
34009-0111
US

IV. Provider business mailing address

PSC 1005 BOX 11000
FPO AA
34009-0111
US

V. Phone/Fax

Practice location:
  • Phone: 757-458-2160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024182294
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001291054
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: