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General NPI Number Information
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NPI Number | 1629688288
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Entity Type | Individual
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Provider Name | JOSEPH TYLER TALLEY PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 121 QUEST CT STE B
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City | KELLER
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State | TX
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Zip | 76248-3748
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Country | US
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Telephone | 630-536-9644
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Fax |
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Provider Business Mailing Address
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Address Line | 121 QUEST CT
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City | KELLER
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State | TX
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Zip | 76248-3748
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Country | US
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Telephone | 817-431-9199
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Fax | 833-973-3672
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15551
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License Number State | TX
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