=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417828344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEOLA BELLAMY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2025
-----------------------------------------------------
Last Update Date | 11/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 COUNTY ROAD 313
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75951-6891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-310-5871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 COUNTY ROAD 313
-----------------------------------------------------
City | JASPER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75951-6891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-310-5871
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------