Healthcare Provider Details

I. General information

NPI: 1225339187
Provider Name (Legal Business Name): TERRY ANN GYDE CPM,LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERRY ANN GYDE CPM, LM

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 07/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S ROGERS ST
WAXAHACHIE TX
75165
US

IV. Provider business mailing address

612 S ROGERS ST
WAXAHACHIE TX
75165-4114
US

V. Phone/Fax

Practice location:
  • Phone: 817-727-5529
  • Fax: 817-887-1537
Mailing address:
  • Phone: 817-727-5529
  • Fax: 817-887-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99138
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: