Healthcare Provider Details

I. General information

NPI: 1467220665
Provider Name (Legal Business Name): MARI SYKES LICENSED MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 W WADLEY AVE UNIT A-230
MIDLAND TX
79707-5330
US

IV. Provider business mailing address

4907 KEENLAND DR
MIDLAND TX
79707-1439
US

V. Phone/Fax

Practice location:
  • Phone: 432-352-4868
  • Fax:
Mailing address:
  • Phone: 432-352-4868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99541
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: