Healthcare Provider Details

I. General information

NPI: 1275066052
Provider Name (Legal Business Name): JESSICA MISTY BOWAB COTA, CHW, DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5589 GREENWICH RD
VIRGINIA BEACH VA
23462-6565
US

IV. Provider business mailing address

1209 CLAYTOR CT
CHESAPEAKE VA
23320-8183
US

V. Phone/Fax

Practice location:
  • Phone: 757-401-4435
  • Fax:
Mailing address:
  • Phone: 915-276-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number212675
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: