MEDICARE: BLISSFUL HEART, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164172185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISSFUL HEART, PLLC

Provider Business Mailing Address
First Line	:	3104 SEMMES AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3759
Country	:	US
Telephone Number	:	804-531-4180
Fax Number	:	804-250-9960

Provider Business Practice Location Address
First Line	:	3104 SEMMES AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-3759
Country	:	US
Telephone Number	:	804-531-4180
Fax Number	:	804-250-9960

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	JACQUELINE BLISS BOONE
Credential	:	NP
Telephone Number	:	804-847-0765

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	01/21/2026

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Directions to “BLISSFUL HEART, PLLC ” Practice Location

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