Healthcare Provider Details

I. General information

NPI: 1801782404
Provider Name (Legal Business Name): TALIA RENEA LOMAX PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 IL ROUTE 162 SUITE 201
MARYVILLE IL
62062
US

IV. Provider business mailing address

315 LEVIN DR
CAHOKIA IL
62206-1539
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-5019
  • Fax: 618-288-5059
Mailing address:
  • Phone: 618-671-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.032530
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: