Physician Compare National (NPI:1720402365)

HEALTHCARE PROVIDER: PHILIP TALLEY FNP

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1720402365
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163640996
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170324000371
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TALLEY
	Individual professional last name
Provider First Name	PHILIP
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1500 W SOUTHLAKE BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 120
	Group Practice or individual's line 2 address
City	SOUTHLAKE
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	760925951
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y