Provider Demographics
NPI:1013315035
Name:BLUE RIDGE BIRTH
Entity Type:Organization
Organization Name:BLUE RIDGE BIRTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROFESSIONAL MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:BROWN
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:703-727-3053
Mailing Address - Street 1:96 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:BLUEMONT
Mailing Address - State:VA
Mailing Address - Zip Code:20135-4854
Mailing Address - Country:US
Mailing Address - Phone:703-727-3053
Mailing Address - Fax:
Practice Address - Street 1:96 LOCUST LN
Practice Address - Street 2:
Practice Address - City:BLUEMONT
Practice Address - State:VA
Practice Address - Zip Code:20135-4854
Practice Address - Country:US
Practice Address - Phone:703-727-3053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000086176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty