Provider Demographics
NPI:1366621344
Name:TALLEY, LOIS J (PA)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:J
Last Name:TALLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TALLEY
Other - Middle Name:J
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1080 N GREEN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2419
Mailing Address - Country:US
Mailing Address - Phone:317-386-5618
Mailing Address - Fax:317-386-5463
Practice Address - Street 1:1080 N GREEN ST STE 150
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2419
Practice Address - Country:US
Practice Address - Phone:317-386-5618
Practice Address - Fax:317-386-5463
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000303A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant