Healthcare Provider Details

I. General information

NPI: 1558835512
Provider Name (Legal Business Name): BORN MIDWIFERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2019
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 N CROMWELL DR
WICHITA KS
67204-4447
US

IV. Provider business mailing address

1130 S CLIFTON AVE
WICHITA KS
67218-2913
US

V. Phone/Fax

Practice location:
  • Phone: 316-209-3559
  • Fax: 316-803-1562
Mailing address:
  • Phone: 316-247-2095
  • Fax: 316-803-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: KYLE PARISH
Title or Position: OWNER
Credential: CPM
Phone: 316-209-3559