Provider Demographics
NPI:1699215137
Name:TALLEY, KRISTEL (RN)
Entity type:Individual
Prefix:
First Name:KRISTEL
Middle Name:
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 1:11950 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3129
Mailing Address - Country:US
Mailing Address - Phone:907-227-5306
Mailing Address - Fax:907-929-3121
Practice Address - Street 1:3120 W 79TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4406
Practice Address - Country:US
Practice Address - Phone:907-929-3120
Practice Address - Fax:907-929-3121
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101221310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK814482636Medicaid