Provider Demographics
NPI:1528339116
Name:TALLEY, CATHERINE FORD (RN)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:FORD
Last Name:TALLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80093
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-0093
Mailing Address - Country:US
Mailing Address - Phone:800-684-0857
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-7163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN 115596363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2191012Medicaid
LA3D039CQ60Medicare PIN