Provider Demographics
NPI:1164172185
Name:BLISSFUL HEART, PLLC
Entity Type:Organization
Organization Name:BLISSFUL HEART, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:BLISS
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:304-777-0512
Mailing Address - Street 1:14321 WINTER BREEZE DR STE 67
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2452
Mailing Address - Country:US
Mailing Address - Phone:804-505-3010
Mailing Address - Fax:804-250-9960
Practice Address - Street 1:14321 WINTER BREEZE DR STE 67
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2452
Practice Address - Country:US
Practice Address - Phone:804-505-3010
Practice Address - Fax:804-250-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty