Provider Demographics
NPI:1861244980
Name:TALLEY, RENIDA SUEZ (LPN)
Entity type:Individual
Prefix:
First Name:RENIDA
Middle Name:SUEZ
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 KIRBY PKWY
Mailing Address - Street 2:STE 1/215
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-584-6565
Mailing Address - Fax:
Practice Address - Street 1:1779 KIRBY PKWY
Practice Address - Street 2:STE 1/215
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-584-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X, 343900000X
TN3918376G00000X, 376G00000X
TN94331164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No376G00000XNursing Service Related ProvidersNursing Home Administrator
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse