MEDICARE: JOHN RICHARD TALLERDAY PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0998726-NP	CO

General Provider Information

NPI Number	:	1154013548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RICHARD TALLERDAY PMHNP-BC

Provider Business Mailing Address
First Line	:	2525 S DOWNING ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5817
Country	:	US
Telephone Number	:	303-765-6969
Fax Number	:	303-778-5661

Provider Business Practice Location Address
First Line	:	2525 S DOWNING ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5817
Country	:	US
Telephone Number	:	303-765-6969
Fax Number	:	303-778-5661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2023
Last Update Date	:	04/13/2026

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