Provider Demographics
NPI:1730839358
Name:TALBERT, KARISSA ELIZABETH
Entity type:Individual
Prefix:MS
First Name:KARISSA
Middle Name:ELIZABETH
Last Name:TALBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KARISSA
Other - Middle Name:ELIZABETH
Other - Last Name:BURCHNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:775 E ELIZA ST
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-1486
Mailing Address - Country:US
Mailing Address - Phone:567-371-4418
Mailing Address - Fax:
Practice Address - Street 1:775 E ELIZA ST
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-1486
Practice Address - Country:US
Practice Address - Phone:567-371-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator