Provider Demographics
NPI:1457711756
Name:EDWARDS, TRACY (LM)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF
Mailing Address - State:TX
Mailing Address - Zip Code:78112-5543
Mailing Address - Country:US
Mailing Address - Phone:210-288-2777
Mailing Address - Fax:
Practice Address - Street 1:316 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:ELMENDORF
Practice Address - State:TX
Practice Address - Zip Code:78112-5543
Practice Address - Country:US
Practice Address - Phone:210-288-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99261176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife