Provider Demographics
NPI:1174375265
Name:BOONE, JAMYLAH BRENE (CERTIFIED DOULA)
Entity type:Individual
Prefix:MS
First Name:JAMYLAH
Middle Name:BRENE
Last Name:BOONE
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-5541
Mailing Address - Country:US
Mailing Address - Phone:757-514-9129
Mailing Address - Fax:
Practice Address - Street 1:2110 PARKER AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-5541
Practice Address - Country:US
Practice Address - Phone:757-354-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4358374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula