Healthcare Provider Details

I. General information

NPI: 1366133118
Provider Name (Legal Business Name): ROSE CITY MIDWIFERY AND WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 S FLEISHEL AVE
TYLER TX
75701-2042
US

IV. Provider business mailing address

844 S FLEISHEL AVE
TYLER TX
75701-2042
US

V. Phone/Fax

Practice location:
  • Phone: 903-803-2229
  • Fax: 903-385-4195
Mailing address:
  • Phone: 903-803-2229
  • Fax: 903-385-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER N CARMODY
Title or Position: OWNER
Credential: LM, CPM
Phone: 903-803-2229