Healthcare Provider Details

I. General information

NPI: 1598438921
Provider Name (Legal Business Name): RACHEL SOLLY CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 OLD BULLARD RD STE 702
TYLER TX
75703-1215
US

IV. Provider business mailing address

3405 MCDONALD RD
TYLER TX
75701-6127
US

V. Phone/Fax

Practice location:
  • Phone: 936-371-3671
  • Fax: 903-496-0082
Mailing address:
  • Phone: 936-371-3671
  • Fax: 903-496-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99449
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: