# JOHANNA CONGLETON, CNM, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447672357
- **Authorized official:** MALATHI ELLIS MD (PROVIDER/OWNER)
- **Authorized official phone:** (972) 406-9911

## Contact information

- **Practice address:** 9 MEDICAL PKWY PLAZA 4, STE 103, DALLAS, TX 75234-7858
- **Practice address phone:** (972) 406-9911
- **Practice address fax:** (972) 406-9930
- **Mailing address:** 6750 N MACARTHUR BLVD, 100, IRVING, TX 75039-2875
- **Mailing address phone:** (972) 406-9911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367A00000X | Advanced Practice Midwife | CNM1795 | TX | Yes |

## Other

- **Enumeration date:** 01/11/2014
- **Last updated:** 07/27/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 15228 | RX AUTH \# | TX |
| 05 | — | 345079301 | — | TX |
| 01 | — | 744687 | NURSE LICENSE \# | TX |