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General NPI Number Information
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NPI Number | 1376804641
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Entity Type | Individual
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Provider Name | CARLA ELAINE TALLEY ANP-C
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Gender | Female
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Dates
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Enumeration Date | 06/04/2012
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 2326 18TH ST SUITE 210
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City | COLUMBUS
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State | IN
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Zip | 47201-5359
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Country | US
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Telephone | 812-372-8426
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Fax |
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Provider Business Mailing Address
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Address Line | 2326 18TH ST SUITE 210
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City | COLUMBUS
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State | IN
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Zip | 47201-5359
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Country | US
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Telephone |
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN9190141
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71004998A
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License Number State | IN
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