Tina Black – Doula in Kelso, WA

Key facts

NPI: 1083982045
Entity type: Individual (NPI type 1)
Primary specialty: Doula 374J00000X
Practice address: 210 Sparks Dr
Kelso, WA 98626-1818
Phone: (360) 431-8275
NPI assigned: Dec 6, 2011
Sex: Female
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Doula	374J00000X			Yes

Addresses

Primary practice location

210 Sparks Dr
Kelso, WA 98626-1818

Mailing address

PO Box 796
Kelso, WA 98626-0069

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 6, 2011.

{
    "created_epoch": "1323129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323129600000",
    "number": "1083982045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 796",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986260069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 SPARKS DR",
            "city": "KELSO",
            "state": "WA",
            "postal_code": "986261818",
            "telephone_number": "360-431-8275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "TINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-06",
        "last_updated": "2011-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374J00000X",
            "taxonomy_group": "",
            "desc": "Doula",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kelso, WA

All providers in Kelso, WA · Doula in Washington

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 6, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.