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General NPI Number Information
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NPI Number | 1851223036
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Entity Type | Organization
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Legal Business Name | BEACON BIRTH AND WELLNESS
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Dates
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Enumeration Date | 06/01/2026
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Last Update Date | 06/01/2026
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Provider Practice Location Address
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Address Line | 2725 BROTHERS BLVD
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City | COLLEGE STATION
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State | TX
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Zip | 77845-5302
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Country | US
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Telephone | 979-314-9914
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Fax | 979-314-9914
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Provider Business Mailing Address
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Address Line | 2725 BROTHERS BLVD
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City | COLLEGE STATION
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State | TX
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Zip | 77845-5302
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Country | US
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Telephone | 979-314-9914
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Fax | 979-314-9914
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JENNIFER LIGHT
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Credential | DNP, CNM, APRN
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Telephone | 979-314-9914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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