Healthcare Provider Details

I. General information

NPI: 1376804641
Provider Name (Legal Business Name): CARLA ELAINE TALLEY ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 18TH ST SUITE 210
COLUMBUS IN
47201-5359
US

IV. Provider business mailing address

2326 18TH ST SUITE 210
COLUMBUS IN
47201-5359
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-8426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN9190141
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71004998A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: