Provider Demographics
NPI:1588196711
Name:TALLEY, ABIGAIL ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ELIZABETH
Last Name:TALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 BROADWAY STE 211
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5732
Mailing Address - Country:US
Mailing Address - Phone:210-382-6566
Mailing Address - Fax:
Practice Address - Street 1:4940 BROADWAY STE 211
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5732
Practice Address - Country:US
Practice Address - Phone:210-382-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS69562084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry