MEDICARE: KATIE TALLY PA-C

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1598472706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE TALLY PA-C

Provider Business Mailing Address
First Line	:	213 S JEFFERSON ST STE 1006
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24011-1713
Country	:	US
Telephone Number	:	540-224-5352
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 E STUART DR STE D
Second Line	:
City	:	GALAX
State	:	VA
Zip	:	24333-2231
Country	:	US
Telephone Number	:	276-236-5181
Fax Number	:

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

Provider Enumeration Date	:	10/28/2022
Last Update Date	:	06/10/2026

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Directions to “ KATIE TALLY PA-C” Practice Location

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