Provider Demographics
NPI:1073325155
Name:IVORY BLOOM HEALTH PLLC
Entity type:Organization
Organization Name:IVORY BLOOM HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMY-JO
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:910-994-8125
Mailing Address - Street 1:605 BENSON RD STE A
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3987
Mailing Address - Country:US
Mailing Address - Phone:910-994-8125
Mailing Address - Fax:
Practice Address - Street 1:605 BENSON RD STE A
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3987
Practice Address - Country:US
Practice Address - Phone:910-994-8125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty