MEDICARE: ROOTED BIRTH AND WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1447109228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTED BIRTH AND WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	1009 CHESTNUT ST
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-3303
Country	:	US
Telephone Number	:	512-886-7340
Fax Number	:	915-232-9611

Provider Business Practice Location Address
First Line	:	1009 CHESTNUT ST
Second Line	:
City	:	BASTROP
State	:	TX
Zip	:	78602-3303
Country	:	US
Telephone Number	:	512-886-7340
Fax Number	:	915-232-9611

Authorized Official
Title or Position	:	MIDWIFE
Name	:	ELIZABETH TISDALE
Credential	:	CPM, LM
Telephone Number	:	512-866-7340

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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