Provider Demographics
NPI:1275066052
Name:BOWAB, JESSICA MISTY (COTA, CHW, DOULA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MISTY
Last Name:BOWAB
Suffix:
Gender:F
Credentials:COTA, CHW, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 CLAYTOR CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8183
Mailing Address - Country:US
Mailing Address - Phone:915-276-0881
Mailing Address - Fax:
Practice Address - Street 1:5589 GREENWICH RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6565
Practice Address - Country:US
Practice Address - Phone:757-401-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 174N00000X, 374J00000X
TX212675224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No172V00000XOther Service ProvidersCommunity Health Worker
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant