Provider Demographics
NPI:1073525671
Name:TALBERT, JOSHUA (PA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:TALBERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 NORTH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1808
Mailing Address - Country:US
Mailing Address - Phone:936-560-9898
Mailing Address - Fax:
Practice Address - Street 1:4909 NORTH ST STE 202
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1808
Practice Address - Country:US
Practice Address - Phone:936-560-9898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02779363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP14986Medicare UPIN