Healthcare Provider Details

I. General information

NPI: 1427794791
Provider Name (Legal Business Name): TALISIA MCMURRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 KILPATRICK BLVD STE 100
MONROE LA
71201-5156
US

IV. Provider business mailing address

305 E MISSISSIPPI AVE
RUSTON LA
71270-3905
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8050
  • Fax:
Mailing address:
  • Phone: 318-202-3706
  • Fax: 318-202-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: