Basic Information
| Provider Information | |||||||||
| NPI: | 1942330014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALLMAN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | RN, APN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 KENSINGTON PL | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384018885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314461537 | ||||||||
| FaxNumber: | 9313800677 | ||||||||
| Practice Location | |||||||||
| Address1: | 6107 PINEWOOD RD | ||||||||
| Address2: | |||||||||
| City: | NUNNELLY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371372523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888526672 | ||||||||
| FaxNumber: | 3058914228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN0000135328 | TN | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | APN14483 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.