Provider Demographics
NPI:1942330014
Name:TALLMAN, JASON MATTHEW (RN, APN-BC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:TALLMAN
Suffix:
Gender:M
Credentials:RN, APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:109 KENSINGTON PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-8885
Mailing Address - Country:US
Mailing Address - Phone:931-446-1537
Mailing Address - Fax:931-380-0677
Practice Address - Street 1:6107 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:NUNNELLY
Practice Address - State:TN
Practice Address - Zip Code:37137-2523
Practice Address - Country:US
Practice Address - Phone:888-852-6672
Practice Address - Fax:305-891-4228
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY873397-01163WP0808X
TNRN0000135328163WP0808X
NYF404803-01363LP0808X
TNAPN14483363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health