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General NPI Number Information
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NPI Number | 1750895223
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Entity Type | Individual
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Provider Name | THERESA JULIETTE TALLEY APN CPNP-AC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 6410 FANNIN ST STE 330
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City | HOUSTON
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State | TX
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Zip | 77030-3004
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Country | US
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Telephone | 832-325-7288
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Fax |
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Provider Business Mailing Address
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Address Line | 835 SUGAR MAPLE FOREST ST
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City | CROSBY
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State | TX
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Zip | 77532-5633
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Country | US
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Telephone | 815-207-0950
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 209.019646
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 18584
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1175137
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License Number State | TX
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