Provider Demographics
NPI:1265686083
Name:TALLEY, LYNETTE MARIE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:MARIE
Last Name:TALLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3737
Mailing Address - Country:US
Mailing Address - Phone:229-928-3444
Mailing Address - Fax:229-928-3446
Practice Address - Street 1:603 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3737
Practice Address - Country:US
Practice Address - Phone:229-928-3444
Practice Address - Fax:229-928-3446
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156813176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA738979380AMedicaid
GARN156813OtherCNM LICENSE
10435OtherACNM CERTIFICATION