Active NPI
Crystal Jackson, BIRTH DOULA
- Doula
- Upper Marlboro, MD
National Provider Identifier
1144944075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Doula
- Practice address
- 4120 Tudor Rd
Upper Marlboro, MD 20772-9374 - Phone
- (240) 360-1383
- NPI assigned
- Oct 4, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Doula | 374J00000X | Primary |
Addresses
Primary practice location
4120 Tudor Rd
Upper Marlboro, MD 20772-9374
Mailing address
4120 Tudor Rd
Upper Marlboro, MD 20772-9374
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| A Queen Momma Doula Services LLC | Doula | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Doula
- Upper Marlboro, MD
- NPI 1538945787
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664841600000",
"number": "1144944075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4120 TUDOR RD",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207729374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4120 TUDOR RD",
"city": "UPPER MARLBORO",
"state": "MD",
"postal_code": "207729374",
"telephone_number": "240-360-1383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "CRYSTAL",
"credential": "BIRTH DOULA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-04",
"last_updated": "2022-10-04",
"certification_date": "2022-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Upper Marlboro, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.