Provider Demographics
NPI:1588029029
Name:TALLEY, PAULA KAYE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:KAYE
Last Name:TALLEY
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KAYE
Other - Last Name:TALLEY-PUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:1101 E MARSHALL ST RM 7-013
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5008
Mailing Address - Country:US
Mailing Address - Phone:804-827-2119
Mailing Address - Fax:
Practice Address - Street 1:1101 E. MARSHALL ST.
Practice Address - Street 2:DEPT. OF DIABETES & ENDOCRINOLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-827-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172855363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care