Provider Demographics
NPI:1225654700
Name:BLACKWOOD, PAYTON HAYLIE (DOULA, PPD, CBE)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:HAYLIE
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:DOULA, PPD, CBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 BOAT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-2602
Mailing Address - Country:US
Mailing Address - Phone:817-888-2172
Mailing Address - Fax:
Practice Address - Street 1:4201 BOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2602
Practice Address - Country:US
Practice Address - Phone:817-888-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174H00000X, 174N00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty