MEDICARE: TAYLEIGH J TALMADGE

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	2255A2300X	Athletic Trainer
2	363A00000X	Physician Assistant	PA3440	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22	OTHER	MT	AT

General Provider Information

NPI Number	:	1306368766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLEIGH J TALMADGE

Provider Business Mailing Address
First Line	:	221 SEVEN PALMS CIR
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-1827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 N BUFFALO DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-0307
Country	:	US
Telephone Number	:	702-852-1390
Fax Number	:

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

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	05/25/2026

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