Healthcare Provider Details

I. General information

NPI: 1508395070
Provider Name (Legal Business Name): BORN2BABLESSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E BROAD ST
MANSFIELD TX
76063-7703
US

IV. Provider business mailing address

1427 LAUREL LN
CLEBURNE TX
76033-7621
US

V. Phone/Fax

Practice location:
  • Phone: 817-727-5529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: TERRY GYDE
Title or Position: OWNER
Credential: CPM, LM
Phone: 817-727-5529