Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99353 | TX |
NPI | 1073089983 |
---|---|
Provider Name | Kristin Marie Youngblood |
First Address | Liberty Hill, TX 78642-4513 |
Second Address | Liberty Hill, TX 78642-4513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2018 |
Last Update Date | 18/10/2018 |