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General NPI Number Information
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NPI Number | 1700877412
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Entity Type | Individual
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Provider Name | JANE E KELLEY TALLMAN DO
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Gender | Female
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 100 TAYLOR LN
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City | RONCEVERTE
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State | WV
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Zip | 24970-1337
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Country | US
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Telephone | 304-647-3434
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Fax | 304-647-9789
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Provider Business Mailing Address
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Address Line | PO BOX 787
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City | CRAB ORCHARD
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State | WV
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Zip | 25827-0787
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Country | US
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Telephone | 304-253-5793
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Fax | 304-253-0166
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1770
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1770
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License Number State | WV
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