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General NPI Number Information
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NPI Number | 1447109228
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Entity Type | Organization
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Legal Business Name | ROOTED BIRTH AND WELLNESS, PLLC
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Dates
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Enumeration Date | 01/26/2026
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 1009 CHESTNUT ST
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City | BASTROP
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State | TX
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Zip | 78602-3303
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Country | US
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Telephone | 512-886-7340
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Fax | 915-232-9611
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Provider Business Mailing Address
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Address Line | 1009 CHESTNUT ST
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City | BASTROP
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State | TX
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Zip | 78602-3303
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Country | US
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Telephone | 512-886-7340
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Fax | 915-232-9611
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Authorized Official
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Title or Position | MIDWIFE
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Name | ELIZABETH TISDALE
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Credential | CPM, LM
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Telephone | 512-866-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State |
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