=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114911161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE JANICE TALBOT D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2005
-----------------------------------------------------
Last Update Date | 12/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 N KING ST SUITE 103
-----------------------------------------------------
City | SEGUIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78155-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-372-5200
-----------------------------------------------------
Fax | 830-372-5202
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 515 N KING ST SUITE 103
-----------------------------------------------------
City | SEGUIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78155-4801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-372-5200
-----------------------------------------------------
Fax | 830-372-5202
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5657
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | M4578
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------