Healthcare Provider Details

I. General information

NPI: 1164172185
Provider Name (Legal Business Name): BLISSFUL HEART, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 SEMMES AVE
RICHMOND VA
23225-3759
US

IV. Provider business mailing address

3104 SEMMES AVE
RICHMOND VA
23225-3759
US

V. Phone/Fax

Practice location:
  • Phone: 804-531-4180
  • Fax: 804-250-9960
Mailing address:
  • Phone: 804-571-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE BLISS BOONE
Title or Position: OWNER/CEO
Credential: NP
Phone: 804-847-0765