Provider Demographics
NPI:1972903151
Name:MIDDLETON, TRESS LAREE
Entity Type:Individual
Prefix:
First Name:TRESS
Middle Name:LAREE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1486
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-3486
Mailing Address - Country:US
Mailing Address - Phone:859-868-7168
Mailing Address - Fax:
Practice Address - Street 1:1512 FLAT GAP RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-8527
Practice Address - Country:US
Practice Address - Phone:859-868-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula