Jessica Brunot Bouldin, CLC, CD

Primary specialty

Lactation Consultant (Non-RN)Taxonomy code 174N00000X

License

351584 Issued in VA

Practice address

102 Apache Trail
Winchester, VA 22602-1300

Phone

(540) 222-8700

NPI assigned

Mar 7, 2023

Last updated

Dec 20, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1174223358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 APACHE TRAIL",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226021300",
            "telephone_number": "540-222-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 APACHE TRAIL",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226021300",
            "telephone_number": "540-222-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDIN",
        "first_name": "JESSICA",
        "middle_name": "BRUNOT",
        "name_prefix": "Mrs.",
        "credential": "CLC, CD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-07",
        "last_updated": "2023-12-20",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "",
            "desc": "Lactation Consultant, Non-RN",
            "state": "VA",
            "license": "351584",
            "primary": true
        },
        {
            "code": "374J00000X",
            "taxonomy_group": "",
            "desc": "Doula",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81180",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• D. Gregory Bott, M.D.
• Jeffrey S Botta, DPT
• Kelly Ann Botta, PA-C
• Timothy Bouck, MD
• T. Glen Bouder, MD
• Marissa Boutin
• Steven S Bowen
• Timothy Keefe Bowers Jr., MD
• Tina Bowers, PHARM. D
• Dana Lynn Bowman, LPC

• Lactation Consultant (Non-RN) in Winchester, VA
• Providers in Winchester, VA by specialty
• Lactation Consultant (Non-RN) in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.