Provider Demographics
NPI:1891223392
Name:IN BLOOM HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:IN BLOOM HEALTHCARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED PRACTICE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JAYMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-389-0810
Mailing Address - Street 1:3704 TRENT COVE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1479
Mailing Address - Country:US
Mailing Address - Phone:281-389-0810
Mailing Address - Fax:281-892-1090
Practice Address - Street 1:712 10TH ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-5116
Practice Address - Country:US
Practice Address - Phone:409-768-0005
Practice Address - Fax:281-892-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113162363LF0000X
TX119382367A00000X
TX99119367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty