=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396570156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAVE KNIGHT ENTERPRISES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2024
-----------------------------------------------------
Last Update Date | 09/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 SW 15TH AVE
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79102-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-772-6431
-----------------------------------------------------
Fax | 806-517-2254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 SW 15TH AVE
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79102-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-772-6431
-----------------------------------------------------
Fax | 806-517-2254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MIDWIFE/DIRECTOR
-----------------------------------------------------
Name | SANDRA JEAN ELKINS
-----------------------------------------------------
Credential | MIDWIFE
-----------------------------------------------------
Telephone | 806-626-4963
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------