Provider Demographics
NPI:1508448457
Name:RHEAD, TALMAGE (PA-C)
Entity Type:Individual
Prefix:
First Name:TALMAGE
Middle Name:
Last Name:RHEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TALMAGE
Other - Middle Name:
Other - Last Name:ALDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5546
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5546
Mailing Address - Country:US
Mailing Address - Phone:801-475-3500
Mailing Address - Fax:801-475-3494
Practice Address - Street 1:185 S 400 E STE 100
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4862
Practice Address - Country:US
Practice Address - Phone:801-397-6200
Practice Address - Fax:801-397-6201
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12997929-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant