Healthcare Provider Details

I. General information

NPI: 1194084707
Provider Name (Legal Business Name): MY BABY BUMP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 HIGHWAY 76 STE 104
CLARKSVILLE TN
37043-5396
US

IV. Provider business mailing address

894 HIGHWAY 76 STE 104
CLARKSVILLE TN
37043-5396
US

V. Phone/Fax

Practice location:
  • Phone: 931-358-2229
  • Fax:
Mailing address:
  • Phone: 931-358-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9281
License Number StateTN

VIII. Authorized Official

Name: MRS. JESSICA LAVOISE
Title or Position: PRESIDENT, LEAD SONOGRAPHER
Credential: ARDMS
Phone: 931-980-8070