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General NPI Number Information
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NPI Number | 1629962592
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Entity Type | Organization
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Legal Business Name | BLOOM WITH HOPE PLLC
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 951 FAIRFAX ST STE F
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City | CARLYLE
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State | IL
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Zip | 62231-1845
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Country | US
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Telephone | 618-702-9078
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Fax |
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Provider Business Mailing Address
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Address Line | 951 FAIRFAX ST STE F
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City | CARLYLE
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State | IL
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Zip | 62231-1845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PMHNP-C
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Name | KAYLA PRYOR
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Credential | APRN-FPA
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Telephone | 618-702-9078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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