Blake, Kelley E
Blake, Kelley E is an individual health care provider with primary practice located at 3332 W Main St Ste 2 , Dothan AL 36305-1019. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Blake, Kelley E can be contacted via phone (334) 246-2577.Contact Information
Primary practice address
3332 W Main St Ste 2
Dothan AL 36305-1019
Phone: (334) 246-2577
Fax: (949) 561-5764
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 1-150592 | Alabama |
Profile Details
| NPI number | 1770737249 |
|---|---|
| LBN Legal business name | Blake, Kelley E |
| Credentials | CRNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 11th, 2008 |
| Last updated | Jun 18th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770737249 | NPPES |
| Alabama | MEDICAID | 181693 |
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