Healthcare Provider Details

I. General information

NPI: 1972215077
Provider Name (Legal Business Name): MS. ASYIA DENISHA JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 LEXINGTON CT
VIRGINIA BEACH VA
23464-2102
US

IV. Provider business mailing address

6110B LEXINGTON CT
VIRGINIA BEACH VA
23464-2102
US

V. Phone/Fax

Practice location:
  • Phone: 757-504-0716
  • Fax:
Mailing address:
  • Phone: 757-504-0716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number3561
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: