Provider Demographics
NPI:1922318914
Name:BOUGHTON, JAYMEE CELESTE (CPM, LM)
Entity Type:Individual
Prefix:
First Name:JAYMEE
Middle Name:CELESTE
Last Name:BOUGHTON
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:281-993-8632
Mailing Address - Fax:
Practice Address - Street 1:3704 TRENT COVE LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1479
Practice Address - Country:US
Practice Address - Phone:281-993-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10090005176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife