Provider Demographics
NPI:1336131614
Name:TALLON, TERESA (ARNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TALLON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-5901
Mailing Address - Fax:859-301-5940
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:ST. ELIZABETH HEALTHCARE WOUND CARE DEPT
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-1100
Practice Address - Fax:859-655-1102
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN262226163W00000X
KY1074586163WW0000X
OHAPRN.CNP.06510363L00000X
KY3003070363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78003845Medicaid
OH2376861Medicaid
OHNP12532Medicare PIN
KY0969434Medicare PIN
KY78003845Medicaid
KYP400014783Medicare PIN
KY0387433Medicare PIN
OHH143941Medicare PIN
KYP00056937Medicare PIN
P00305981Medicare PIN
OH2376861Medicaid
KY3313216Medicare PIN
OHNP12531Medicare PIN