Individual
AMETHYST FAGAN TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPM
Contact information
Practice address
4100 SWISS AVE, DALLAS, TX 75204-6661
(214) 228-1392
(214) 764-0885
Mailing address
4100 SWISS AVE, DALLAS, TX 75204-6661
(214) 228-1392
(214) 764-0885
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
99337
TX
Other
Enumeration date
06/17/2018
Last updated
01/31/2023
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