Provider Demographics
NPI:1508353400
Name:BRAUDAWAY, MEREDITH (CPM, LM)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:BRAUDAWAY
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2513
Mailing Address - Country:US
Mailing Address - Phone:817-962-0004
Mailing Address - Fax:817-549-5430
Practice Address - Street 1:1001 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2513
Practice Address - Country:US
Practice Address - Phone:817-962-0004
Practice Address - Fax:817-549-5430
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX150085261QB0400X
TX99356176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty