Provider Demographics
NPI:1710203542
Name:TALLEY, KATIE ELIZABETH (BA)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:TALLEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:KETCHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:3001 KATHY LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8245
Mailing Address - Country:US
Mailing Address - Phone:405-248-3240
Mailing Address - Fax:
Practice Address - Street 1:2231 IRON MOUND RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5778
Practice Address - Country:US
Practice Address - Phone:405-282-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator