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General NPI Number Information
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NPI Number | 1003656638
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Entity Type | Organization
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Legal Business Name | BLOOM AND BLOSSOM, LLC
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 7152 KYLES CREEK DR
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City | FAIRVIEW
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State | TN
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Zip | 37062-7342
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Country | US
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Telephone | 629-254-9091
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Fax | 615-468-7990
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Provider Business Mailing Address
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Address Line | 7152 KYLES CREEK DR
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City | FAIRVIEW
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State | TN
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Zip | 37062-7342
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Country | US
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Telephone | 629-254-9091
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Fax | 615-468-7990
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | TABITHA PHILLIPS BASSETT
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Credential | RN, BSN, IBCLC
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Telephone | 256-431-6561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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