Healthcare Provider Details

I. General information

NPI: 1750491429
Provider Name (Legal Business Name): PAMELA TALLEY CNS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5261 DELMAR SUITE 206
ST LOUIS MO
63108
US

IV. Provider business mailing address

PO BOX 4851
ST LOUIS MO
63108-0851
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-7542
  • Fax: 314-652-7985
Mailing address:
  • Phone: 314-652-7542
  • Fax: 314-652-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number089783
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1989
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: