# WILD MOTHER PATH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Queen City Doulas
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659161842
- **Authorized official:** KAITLYN BLANCHE MARIE FOSTER NP, RN (MEMBER)
- **Authorized official phone:** (704) 268-9194

## Contact information

- **Practice address:** 12821 JACKS LN, PINEVILLE, NC 28134-6430
- **Practice address phone:** (704) 268-9194
- **Mailing address:** 12821 JACKS LN, PINEVILLE, NC 28134-6430
- **Mailing address phone:** (704) 268-9194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174N00000X | Lactation Consultant (Non-RN) | — | NULL | — |
| 174N00000X | Lactation Consultant (Non-RN) | — | — | — |
| 374J00000X | Doula | — | NULL | Yes |
| 374J00000X | Doula | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2025
- **Last updated:** 05/09/2025