MEDICARE: DR. JAMIE CROUSE GWYNN LM

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	99632	TX

General Provider Information

NPI Number	:	1578164273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE CROUSE GWYNN LM

Provider Business Mailing Address
First Line	:	2304 DOVETAIL ST
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-6521
Country	:	US
Telephone Number	:	254-458-1158
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 DOVETAIL ST
Second Line	:
City	:	PFLUGERVILLE
State	:	TX
Zip	:	78660-6521
Country	:	US
Telephone Number	:	254-458-1158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2020
Last Update Date	:	03/21/2026

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