Provider Demographics
NPI:1457334971
Name:FLAGG, TALISYN JESSICA (CNM)
Entity Type:Individual
Prefix:MS
First Name:TALISYN
Middle Name:JESSICA
Last Name:FLAGG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 VANDALIA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1312
Mailing Address - Country:US
Mailing Address - Phone:800-268-9150
Mailing Address - Fax:651-696-5543
Practice Address - Street 1:671 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1312
Practice Address - Country:US
Practice Address - Phone:800-268-9150
Practice Address - Fax:651-696-5543
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF155090363LW0102X
NE112886363LW0102X
SDCP001223363LW0102X
NDR444428363LW0102X
MN3291363LW0102X
MN213367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN620980700Medicaid
WI41255400Medicaid
MN620980700Medicaid
MN420000496Medicare PIN