Provider Demographics
NPI:1184929788
Name:KING-TALLEY, CHRISTINA CHIARA (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:CHIARA
Last Name:KING-TALLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:CHIARA
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:808 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3045
Mailing Address - Country:US
Mailing Address - Phone:360-683-5900
Mailing Address - Fax:360-582-4804
Practice Address - Street 1:808 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-683-5900
Practice Address - Fax:360-582-4804
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN 198319-NP363LF0000X
AK1205363LF0000X
WAAP30007376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1571281Medicaid
MA NP1954OtherHCFA MEDICARE PART B