Provider Demographics
NPI:1679655062
Name:TALBERT, BETH (LPN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:TALBERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:GRACIA
Other - Middle Name:E
Other - Last Name:TALBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:135 GUILLEBEAU STREET
Mailing Address - Street 2:P.O.BOX 55
Mailing Address - City:LINCOLNTON
Mailing Address - State:GA
Mailing Address - Zip Code:30817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:176 N. PEACHTREE STREET
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:GA
Practice Address - Zip Code:30817
Practice Address - Country:US
Practice Address - Phone:706-359-3154
Practice Address - Fax:706-359-1939
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN018650164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse