Provider Demographics
NPI:1629688288
Name:TALLEY, JOSEPH TYLER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:TYLER
Last Name:TALLEY
Suffix:
Gender:M
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 1:3113 109TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-5882
Mailing Address - Country:US
Mailing Address - Phone:806-252-2268
Mailing Address - Fax:
Practice Address - Street 1:121 QUEST CT STE B
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3748
Practice Address - Country:US
Practice Address - Phone:630-536-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program