Healthcare Provider Details

I. General information

NPI: 1336680719
Provider Name (Legal Business Name): DEVON TALBERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 NE MCBAINE DR
LEES SUMMIT MO
64064-7880
US

IV. Provider business mailing address

2550 N THUNDERBIRD CIR STE 303
MESA AZ
85215-1219
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-2600
  • Fax:
Mailing address:
  • Phone: 480-455-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005004
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: