Provider Demographics
NPI:1659671741
Name:TALLBEAR, SANDRA KAY
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:KAY
Last Name:TALLBEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:KAY
Other - Last Name:STINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE MIDWIFE
Mailing Address - Street 1:705 BELMONT DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6311
Mailing Address - Country:US
Mailing Address - Phone:512-863-0707
Mailing Address - Fax:
Practice Address - Street 1:705 BELMONT DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6311
Practice Address - Country:US
Practice Address - Phone:512-863-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX592364163W00000X, 367A00000X
CA407016 968367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse