Provider Demographics
NPI:1750491429
Name:TALLEY, PAMELA (CNS APRN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:TALLEY
Suffix:
Gender:F
Credentials:CNS APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4851
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-0851
Mailing Address - Country:US
Mailing Address - Phone:314-652-7542
Mailing Address - Fax:314-652-7985
Practice Address - Street 1:5261 DELMAR
Practice Address - Street 2:SUITE 206
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-652-7542
Practice Address - Fax:314-652-7985
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1989101YA0400X
MO089783364SP0808X
IL364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health