=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881307585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY MIDWIFERY & BIRTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2022
-----------------------------------------------------
Last Update Date | 12/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 741 HOLDER ROAD
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76041-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-872-7689
-----------------------------------------------------
Fax | 469-694-8464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 721 HOLDER ROAD
-----------------------------------------------------
City | WAXAHACHIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76041-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-872-7689
-----------------------------------------------------
Fax | 469-694-8464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, CERTIFIED NURSE-MIDWIFE
-----------------------------------------------------
Name | MRS. ASHLEY ANDRAIA GREENE
-----------------------------------------------------
Credential | MS, APRN, CNM
-----------------------------------------------------
Telephone | 972-827-7689
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------