MEDICARE: MARLYS SPIKES 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
1	367A00000X	Advanced Practice Midwife	589993	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	420000834	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386688067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLYS SPIKES CNM

Provider Business Mailing Address
First Line	:	6100 HARRIS PKWY
Second Line	:	#245
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4131
Country	:	US
Telephone Number	:	817-346-5336
Fax Number	:	817-346-5366

Provider Business Practice Location Address
First Line	:	6100 HARRIS PKWY
Second Line	:	#245
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4131
Country	:	US
Telephone Number	:	817-346-5336
Fax Number	:	817-346-5366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/15/2010

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Directions to “ MARLYS SPIKES CNM” Practice Location

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