Provider Demographics
NPI:1467479170
Name:DEMING, MARTHA KAY (RN, MSN,CNM)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:KAY
Last Name:DEMING
Suffix:
Gender:F
Credentials:RN, MSN,CNM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3571 COUNTY ROAD NE 2110
Mailing Address - Street 2:
Mailing Address - City:TALCO
Mailing Address - State:TX
Mailing Address - Zip Code:75487-4835
Mailing Address - Country:US
Mailing Address - Phone:903-379-3283
Mailing Address - Fax:903-572-0696
Practice Address - Street 1:106 2ND ST NW
Practice Address - Street 2:
Practice Address - City:BOGATA
Practice Address - State:TX
Practice Address - Zip Code:75417-2451
Practice Address - Country:US
Practice Address - Phone:903-632-0078
Practice Address - Fax:903-632-1825
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX233995367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036605602Medicaid
TX87N757OtherBLUE CROSS BLUE SHIELD
TX36605601Medicaid
TX036605602Medicaid