Provider Demographics
NPI:1376804641
Name:TALLEY, CARLA ELAINE (ANP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ELAINE
Last Name:TALLEY
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 18TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2326 18TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5359
Practice Address - Country:US
Practice Address - Phone:812-372-8426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9190141363LA2200X
IN71004998A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000990888OtherANTHEM PIN
IN201340570Medicaid
GR933YOtherWELLMED MEDICAL MANAGEMENT OF FLORIDA INC
IN000000990888OtherANTHEM PIN