Sand Creek

Application Materials

Thank you for your interest in Sand Creek’s National Provider Network!

To be considered for membership in Sand Creek’s network, we require the following:
  • Provider Application
  • W-9 Form – only one copy per group needed
  • Copies of Professional License(s) & Certification(s)
  • Copy of liability insurance
  • Resume

Please request a provider application by emailing our Provider Coordinator, Reyna Rios-Starr at reyna@sandcreekeap.com.