# ORIGINS BIRTH SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Origins Birth and Wellness Collective
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003211756
- **Authorized official:** MRS. KAITLYN ELIZABETH WAGES CPM, LM (MIDWIFE/OWNER)
- **Authorized official phone:** (817) 966-8075

## Contact information

- **Practice address:** 10340 ALTA VISTA RD, SUITE 1A, FORT WORTH, TX 76244-6500
- **Practice address phone:** (817) 562-2828
- **Practice address fax:** (817) 768-6940
- **Mailing address:** 10340 ALTA VISTA RD, SUITE 1A, FORT WORTH, TX 76244-6500
- **Mailing address phone:** (817) 562-2828
- **Mailing address fax:** (817) 768-6940

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 175M00000X | Lay Midwife | 99220 | TX | Yes |

## Other

- **Enumeration date:** 10/23/2014
- **Last updated:** 10/23/2014