Provider Demographics
NPI:1013390178
Name:MOTHERLY WAY MATERNITY SERVICES
Entity Type:Organization
Organization Name:MOTHERLY WAY MATERNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:432-687-4645
Mailing Address - Street 1:1201 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6173
Mailing Address - Country:US
Mailing Address - Phone:432-687-4645
Mailing Address - Fax:
Practice Address - Street 1:1201 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6173
Practice Address - Country:US
Practice Address - Phone:432-687-4645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150000176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty