Provider Demographics
NPI:1295505071
Name:ISRAEL, TAB'ITHA BAHT (LM, CPM)
Entity type:Individual
Prefix:
First Name:TAB'ITHA
Middle Name:BAHT
Last Name:ISRAEL
Suffix:
Gender:
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 1:5330 S BUCKNER BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-2003
Mailing Address - Country:US
Mailing Address - Phone:214-701-2409
Mailing Address - Fax:
Practice Address - Street 1:5330 S BUCKNER BLVD # 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-2003
Practice Address - Country:US
Practice Address - Phone:214-701-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X, 374J00000X
TX99604367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula