Provider Demographics
NPI:1043366685
Name:TALBERT, REGINA DAVIS (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:DAVIS
Last Name:TALBERT
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 W MAIN ST
Mailing Address - Street 2:STE G
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1780
Mailing Address - Country:US
Mailing Address - Phone:540-731-4327
Mailing Address - Fax:540-731-4328
Practice Address - Street 1:920 PLANTATION RD STE 104
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3837
Practice Address - Country:US
Practice Address - Phone:540-552-1904
Practice Address - Fax:540-552-2201
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001327231H00000X
VA2102-002314237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043366685Medicaid
VAQ38253AMedicare PIN
VA1043366685Medicaid