Provider Demographics
NPI:1386688067
Name:SPIKES, MARLYS (CNM)
Entity Type:Individual
Prefix:
First Name:MARLYS
Middle Name:
Last Name:SPIKES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 HARRIS PKWY
Mailing Address - Street 2:#245
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4131
Mailing Address - Country:US
Mailing Address - Phone:817-346-5336
Mailing Address - Fax:817-346-5366
Practice Address - Street 1:6100 HARRIS PKWY
Practice Address - Street 2:#245
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4131
Practice Address - Country:US
Practice Address - Phone:817-346-5336
Practice Address - Fax:817-346-5366
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589993367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX420000834OtherMEDICARE RAILROAD
TX042099401Medicaid
TX83500NMedicare ID - Type Unspecified
TX420000834OtherMEDICARE RAILROAD