Healthcare Provider Details

I. General information

NPI: 1851229173
Provider Name (Legal Business Name): SAMANTHA TALLMAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 MEDICAL CENTER DR
WILMINGTON NC
28401-7505
US

IV. Provider business mailing address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

V. Phone/Fax

Practice location:
  • Phone: 910-790-9949
  • Fax:
Mailing address:
  • Phone: 910-343-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024453
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: