Healthcare Provider Details

I. General information

NPI: 1316619240
Provider Name (Legal Business Name): BRIGHT BLESSINGS MIDWIFERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 S FANNIN AVE
TYLER TX
75702-8203
US

IV. Provider business mailing address

514 S FANNIN AVE
TYLER TX
75702-8203
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 Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

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