Provider Demographics
NPI:1154074854
Name:CALICUTT, JADA NAILAH (DOULA)
Entity Type:Individual
Prefix:MRS
First Name:JADA
Middle Name:NAILAH
Last Name:CALICUTT
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1980 AVON DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1223
Mailing Address - Country:US
Mailing Address - Phone:314-287-2588
Mailing Address - Fax:
Practice Address - Street 1:1635 ORANGEDALE LN
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-3050
Practice Address - Country:US
Practice Address - Phone:314-287-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSBD201101494374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula