Provider Demographics
NPI:1164862769
Name:TALLEY, KRISTIE APRIL (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:APRIL
Last Name:TALLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 LAUREL BUSH RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6191
Mailing Address - Country:US
Mailing Address - Phone:410-569-9533
Mailing Address - Fax:410-569-1254
Practice Address - Street 1:2103 LAUREL BUSH RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6191
Practice Address - Country:US
Practice Address - Phone:410-569-9533
Practice Address - Fax:410-569-1254
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165331163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics