Provider Demographics
NPI:1639219629
Name:WINDEBANK, JOY E (CNM)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:E
Last Name:WINDEBANK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:ELAINE
Other - Last Name:RAYME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-927-1065
Mailing Address - Fax:817-927-1162
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-927-1065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX548862367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036892003Medicaid
TX8Y1935OtherBCBS
TX8J4207Medicare PIN
TX8Y1935OtherBCBS