=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609440551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STAND & DELIVER MIDWIFERY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2021
-----------------------------------------------------
Last Update Date | 02/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 975 ROYCE ST
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-361-7250
-----------------------------------------------------
Fax | 850-610-4277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 975 ROYCE ST
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-361-7250
-----------------------------------------------------
Fax | 850-610-4277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNM
-----------------------------------------------------
Name | MRS. KERRY PHAM
-----------------------------------------------------
Credential | APRN, CNM
-----------------------------------------------------
Telephone | 850-380-9335
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------