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General NPI Number Information
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NPI Number | 1164862769
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Entity Type | Individual
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Provider Name | KRISTIE APRIL TALLEY CRNP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 06/27/2013
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Provider Practice Location Address
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Address Line | 2103 LAUREL BUSH RD
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City | BEL AIR
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State | MD
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Zip | 21015-6191
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Country | US
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Telephone | 410-569-9533
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Fax | 410-569-1254
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Provider Business Mailing Address
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Address Line | 2103 LAUREL BUSH RD
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City | BEL AIR
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State | MD
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Zip | 21015-6191
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Country | US
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Telephone | 410-569-9533
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Fax | 410-569-1254
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | R165331
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License Number State | MD
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