Provider Demographics
NPI:1871207654
Name:TALLEY, CALLIE ANN (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:ANN
Last Name:TALLEY
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W KINGSHIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5942
Mailing Address - Country:US
Mailing Address - Phone:870-239-7022
Mailing Address - Fax:
Practice Address - Street 1:1150 E MATTHEWS AVE STE 101A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4356
Practice Address - Country:US
Practice Address - Phone:870-243-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR218059363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner