Provider Demographics
NPI:1306113527
Name:CARMODY, HEATHER N (MIDWIFE)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:CARMODY
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8203
Mailing Address - Country:US
Mailing Address - Phone:903-803-2229
Mailing Address - Fax:
Practice Address - Street 1:514 S FANNIN AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8203
Practice Address - Country:US
Practice Address - Phone:903-803-2229
Practice Address - Fax:903-385-4195
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99453176B00000X
374J00000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN