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
Please request a provider application by emailing our Provider Coordinator, Reyna Rios-Starr at firstname.lastname@example.org.