Healthcare Provider Details

I. General information

NPI: 1992426134
Provider Name (Legal Business Name): JACOB TYLER TALKINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 N MAIN ST UNIT 111
HIGH POINT NC
27262-2167
US

IV. Provider business mailing address

550 WHITE OAK ST
ASHEBORO NC
27203-4710
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-2640
  • Fax:
Mailing address:
  • Phone: 336-625-1360
  • Fax: 336-625-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5019525
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5019525
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: