=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457935439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLISS WOMEN'S WELLNESS & BIRTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2021
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14157 HORSESHOE BND
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77384-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-271-4911
-----------------------------------------------------
Fax | 936-271-4902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14157 HORSESHOE BND
-----------------------------------------------------
City | CONROE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77384-3521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-341-0565
-----------------------------------------------------
Fax | 936-271-4902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED DIETITIAN
-----------------------------------------------------
Name | JACLYN PERKINS
-----------------------------------------------------
Credential | MS, RD, LD
-----------------------------------------------------
Telephone | 936-271-4911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------