Provider Demographics
NPI:1992691323
Name:TALATALA, MARY CHRISTINE (APRN - CNP)
Entity type:Individual
Prefix:MS
First Name:MARY CHRISTINE
Middle Name:
Last Name:TALATALA
Suffix:
Gender:F
Credentials:APRN - CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7104
Mailing Address - Country:US
Mailing Address - Phone:817-296-9646
Mailing Address - Fax:
Practice Address - Street 1:3001 CROSS TIMBERS RD STE 120
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2800
Practice Address - Country:US
Practice Address - Phone:972-350-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner