Individual
LORI TALLEY SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, SUITE 200, DALLAS, TX 75240-6533
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
640967
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP114602
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179065101
—
TX
05
—
179065102
—
TX
05
—
179065103
—
TX
05
—
179065107
—
TX
05
—
179065108
—
TX
01
—
179065109
MEDICAID CSHCN
TX
01
—
179065110
MEDICAID CSHCN
TX
05
—
179065112
—
TX
01
—
86686U
BCBS
TX
01
—
8770UG
BCBS
TX
01
—
P00719291
RAILROAD
TX
01
—
P01358442
RR
TX
Enumeration date
07/17/2006
Last updated
05/06/2020
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