Healthcare Provider Details

I. General information

NPI: 1245694637
Provider Name (Legal Business Name): HEATHER NICOLE TALLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HICKMAN RD
WAUKEE IA
50263-5000
US

IV. Provider business mailing address

30 HICKMAN RD
WAUKEE IA
50263-5000
US

V. Phone/Fax

Practice location:
  • Phone: 515-987-3447
  • Fax:
Mailing address:
  • Phone: 515-987-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD56178
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number62630
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: