Provider Demographics
NPI:1003656638
Name:BLOOM AND BLOSSOM, LLC
Entity type:Organization
Organization Name:BLOOM AND BLOSSOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, IBCLC
Authorized Official - Phone:256-431-6561
Mailing Address - Street 1:7152 KYLES CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-7342
Mailing Address - Country:US
Mailing Address - Phone:629-254-9091
Mailing Address - Fax:615-468-7990
Practice Address - Street 1:7152 KYLES CREEK DR
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:TN
Practice Address - Zip Code:37062-7342
Practice Address - Country:US
Practice Address - Phone:629-254-9091
Practice Address - Fax:615-468-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty