Provider Demographics
NPI:1538793310
Name:RICHIE, TALYA REBECCA (NP)
Entity type:Individual
Prefix:
First Name:TALYA
Middle Name:REBECCA
Last Name:RICHIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 975115
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-5115
Mailing Address - Country:US
Mailing Address - Phone:817-263-0007
Mailing Address - Fax:817-263-1118
Practice Address - Street 1:7801 OAKMONT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4242
Practice Address - Country:US
Practice Address - Phone:817-263-0007
Practice Address - Fax:817-263-1118
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145329363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner