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NPI Code Detail

MEDICARE: JOHANNA CONGLETON BODINE CNM

MEDICARE: JOHANNA CONGLETON BODINE CNM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367A00000XAdvanced Practice MidwifeCNM1795TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2AP124942OTHERTXAPRN
315228OTHERTXRX AUTH #
4744687OTHERTXNURSE LICENSE #

General Provider Information

NPI Number : 1184046096
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHANNA CONGLETON BODINE CNM
Provider Business Mailing Address
First Line : 411 N WASHINGTON AVE STE 2700
Second Line :
City : DALLAS
State : TX
Zip : 75246-1735
Country : US
Telephone Number : 214-975-3937
Fax Number : 469-309-7787
Provider Business Practice Location Address
First Line : 411 N WASHINGTON AVE STE 2700
Second Line :
City : DALLAS
State : TX
Zip : 75246-1735
Country : US
Telephone Number : 214-975-3937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2014
Last Update Date : 03/07/2023

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Directions to “ JOHANNA CONGLETON BODINE CNM” Practice Location

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