Healthcare Provider Details

I. General information

NPI: 1992177240
Provider Name (Legal Business Name): SARAH JONES MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 5TH AVE
FORT WORTH TX
76110
US

IV. Provider business mailing address

2260 5TH AVE
FORT WORTH TX
76110
US

V. Phone/Fax

Practice location:
  • Phone: 817-219-9293
  • Fax: 181-796-1729
Mailing address:
  • Phone: 817-219-9293
  • Fax: 181-796-1729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99053
License Number StateTX

VIII. Authorized Official

Name: SARAH B JONES
Title or Position: OWNER
Credential: CPM, LM
Phone: 817-219-9293