Provider Demographics
NPI:1114525029
Name:CARLISLE, TRICIA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 CAYUGA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3926
Mailing Address - Country:US
Mailing Address - Phone:720-705-1276
Mailing Address - Fax:
Practice Address - Street 1:2500 W WILLIAM CANNON DR STE 503
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5286
Practice Address - Country:US
Practice Address - Phone:512-243-8066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife