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General NPI Number Information
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NPI Number | 1891223392
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Entity Type | Organization
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Legal Business Name | IN BLOOM HEALTHCARE ASSOCIATES
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Dates
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Enumeration Date | 05/27/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 712 10TH ST
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City | GALVESTON
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State | TX
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Zip | 77550-5116
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Country | US
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Telephone | 409-768-0005
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Fax | 281-892-1090
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Provider Business Mailing Address
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Address Line | 3704 TRENT COVE LN
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City | PEARLAND
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State | TX
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Zip | 77584-1479
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Country | US
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Telephone | 281-389-0810
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Fax | 281-892-1090
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Authorized Official
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Title or Position | ADVANCED PRACTICE MIDWIFE
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Name | JAYMEE BOUGHTON
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Credential |
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Telephone | 281-389-0810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 113162
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 99119
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 119382
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License Number State | TX
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