Healthcare Provider Details

I. General information

NPI: 1215140439
Provider Name (Legal Business Name): RIAN LIVISAY TALLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RIAN MICHELE JAMERSON LIVISAY CRNP

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7517 NEW HAMPSHIRE AVE
TAKOMA PARK MD
20912-6969
US

IV. Provider business mailing address

9727 JUNE FLOWERS WAY
LAUREL MD
20723-5619
US

V. Phone/Fax

Practice location:
  • Phone: 240-450-2092
  • Fax:
Mailing address:
  • Phone: 410-258-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1036512
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR207685
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1036512
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR207685
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: