Healthcare Provider Details

I. General information

NPI: 1710453600
Provider Name (Legal Business Name): MY SISTER'S KEEPER BIRTH & MIDWFERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 CHADWICK CT STE 200
HURST TX
76054-3318
US

IV. Provider business mailing address

3512 BRENTWOOD DR
COLLEYVILLE TX
76034-8644
US

V. Phone/Fax

Practice location:
  • Phone: 817-479-0124
  • Fax: 817-280-9962
Mailing address:
  • Phone: 503-317-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: MS. KENNASHA JONES
Title or Position: LICENSED MIDWIFE
Credential: LM
Phone: 503-317-3414