Provider Demographics
NPI:1861017147
Name:TALLENT, MEGHAN KELLY (FNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KELLY
Last Name:TALLENT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LAKESIDE LN
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7413
Mailing Address - Country:US
Mailing Address - Phone:303-422-2236
Mailing Address - Fax:720-360-0266
Practice Address - Street 1:16 LAKESIDE LN
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-7413
Practice Address - Country:US
Practice Address - Phone:303-422-2236
Practice Address - Fax:720-360-0266
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995545-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000186323Medicaid