Individual
MIA TALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8960 COMMERCE DR STE 4E, DE SOTO, KS 66018-8431
(913) 789-3961
Mailing address
8960 COMMERCE DR STE 4E, DE SOTO, KS 66018-8431
(913) 789-3961
(913) 583-3667
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02978
KS
Other
Enumeration date
09/23/2024
Last updated
10/14/2025
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