Provider Demographics
NPI:1144236837
Name:TALLEY, JULIE L (APRN CNM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:TALLEY
Suffix:
Gender:F
Credentials:APRN CNM
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN CNM
Mailing Address - Street 1:825 EUCLID AVENUE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MD
Mailing Address - Zip Code:64124-2323
Mailing Address - Country:US
Mailing Address - Phone:816-474-4920
Mailing Address - Fax:816-474-4914
Practice Address - Street 1:825 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64124-2323
Practice Address - Country:US
Practice Address - Phone:816-474-4920
Practice Address - Fax:816-474-4914
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO130811367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC160380OtherWHEATLANDS
MO130811OtherRN
MO259127702Medicaid
MO130811OtherRN