Organization
JOHANNA CONGLETON, CNM, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALATHI ELLIS MD (PROVIDER/OWNER)
(972) 406-9911
Entity
Organization
Contact information
Practice address
9 MEDICAL PKWY PLAZA 4, STE 103, DALLAS, TX 75234-7858
(972) 406-9911
(972) 406-9930
Mailing address
6750 N MACARTHUR BLVD, 100, IRVING, TX 75039-2875
(972) 406-9911
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
CNM1795
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15228
RX AUTH #
TX
05
—
345079301
—
TX
01
—
744687
NURSE LICENSE #
TX
Enumeration date
01/11/2014
Last updated
07/27/2015
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