Provider Demographics
NPI:1336301886
Name:TALLEY, RENITA C (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RENITA
Middle Name:C
Last Name:TALLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S LAMAR BLVD
Mailing Address - Street 2:HOSPITALIST OFFICE
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5373
Mailing Address - Country:US
Mailing Address - Phone:662-232-8568
Mailing Address - Fax:662-513-1450
Practice Address - Street 1:2301 S LAMAR BLVD
Practice Address - Street 2:HOSPITALIST OFFICE
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5373
Practice Address - Country:US
Practice Address - Phone:662-232-8568
Practice Address - Fax:662-513-1450
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13508363LF0000X
MSR879204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily