Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 96194 | TX |
NPI | 1154988574 |
---|---|
Provider Name | Kelly Ann Baumgartner |
First Address | New Braunfels, TX 78132-2390 |
Second Address | New Braunfels, TX 78132-2390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12909276 | DRIVERS LICENSE (01) | TX |