Healthcare Provider Details

I. General information

NPI: 1124279245
Provider Name (Legal Business Name): BLOOM HEALTH SERVICES FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 430
JACKSON MS
39202-2027
US

IV. Provider business mailing address

1200 N STATE ST STE 430
JACKSON MS
39202-2027
US

V. Phone/Fax

Practice location:
  • Phone: 601-487-7141
  • Fax: 601-487-4170
Mailing address:
  • Phone: 601-487-7141
  • Fax: 601-487-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR857552
License Number StateMS

VIII. Authorized Official

Name: MS. KIMBERLY LYNNE SCHLAGEL
Title or Position: OWNER
Credential: NP
Phone: 601-487-7141