Provider Demographics
NPI:1578713145
Name:TALLEY, SHEILA S (PA-C)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:S
Last Name:TALLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-5470
Mailing Address - Fax:785-354-5475
Practice Address - Street 1:120 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ONAGA
Practice Address - State:KS
Practice Address - Zip Code:66521-9574
Practice Address - Country:US
Practice Address - Phone:785-889-4274
Practice Address - Fax:785-889-4714
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01278363A00000X
KST-02244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00652572OtherRAILROAD MEDICARE
KS200573130AMedicaid
KS200573130AMedicaid