OPAL MULLINGS BLAKE (NPI# 1043629140) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043629140 |
| Entity Type | Individual |
| Full Name | OPAL MULLINGS BLAKE |
| Credential | NP-C |
| Practice Address |
631 Professional Dr Ste 350 Lawrenceville GA 30046-3370 |
| Mailing Address |
631 Professional Dr Suite 350 Lawrenceville GA 30046 |
| Practice Telephone | 7709950630 |
| Practice Fax Number | 7709951555 |
| Mailing Telephone | 7709950630 |
| Mailing Fax Number | 7706820088 |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2016-01-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | RN199200 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363L00000X | Nurse Practitioner | RN 199200 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
631 PROFESSIONAL DR STE 350 |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30046-3370 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538654983 | Antonette Sanderson | Nurse Practitioner | 631 Professional Dr Ste 350, Lawrenceville, GA 30046-3370 | 2018-06-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063023174 | Alpha & Omega Hearing Centers | Hearing Instrument Specialist | Alpha & Omega Hearing Centers, 250 Langley Drive, Suite 1106, Lawrenceville, GA 30046 | 2020-08-12 |
| 1285259846 | Mesun Health Services, Inc | Clinical Nurse Specialist | 88 Johnson Rd Building # 1-b, Lawrenceville, GA 30046 | 2020-06-10 |
| 1215550264 | Mesun Health Services, Inc | Skilled Nursing Facility | 88 Johnson Rd. Building #2, Lawrenceville, GA 30046 | 2020-05-26 |
| 1306499785 | Bryan Acosta | Chiropractor | 471 Scenic Hwy South, Lawrenceville, GA 30046 | 2019-07-24 |
| 1205308616 | Belle Lumiere Cosmetics LLC | Dermatology | 753 Old Norcross Road, Lawrenceville, GA 30046 | 2018-12-24 |
| 1548730179 | Alexis Nicole Robinson | Nurse Anesthetist, Certified Registered | 1000 Medical Center Boulevard, Lawrenceville, GA 30046 | 2018-11-27 |
| 1679060388 | Christopher Puckett | Student in an Organized Health Care Education/Training Program | 665 Duluth Hwy Suite 501, Lawrenceville, GA 30046 | 2018-04-18 |
| 1457851255 | Advanced Urology Institute of Georgia | Urology | 501 Crown Point Way, Lawrenceville, GA 30046 | 2018-02-19 |
| 1013447044 | Pharmacy Investments of Lawrenceville, LLC | Pharmacy | 738 Old Norcross Road, Ste A, Lawrenceville, GA 30046 | 2017-06-13 |
| 1225577000 | Priority Housecalls LLC | Clinic/Center | 225 Scenic Hwy, Ste 200, Lawrenceville, GA 30046 | 2017-02-14 |
| Find all providers in zip 30046 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962017343 | Sarah Mcmillan | Nurse Practitioner | 971 Sonoma Dr, Lawrenceville, GA 30045-7842 | 2020-09-11 |
| 1801406590 | Allyson Fiscus | Nurse Practitioner | 11020 Il-250, Lawrenceville, IL 62439 | 2020-08-06 |
| 1811532963 | Lubna Rizvan Momin | Nurse Practitioner | 542 Sydney Michelle Ln, Lawrenceville, GA 30046-3352 | 2019-11-13 |
| 1255800785 | Vonda Lynn Farrar | Nurse Practitioner | 1918 De Winton Pl, Lawrenceville, GA 30043-5021 | 2018-11-14 |
| 1598234122 | Melisha K John-baptiste | Nurse Practitioner | 4850 Sugarloaf Pkwy Ste 209-190, Lawrenceville, GA 30044-2859 | 2018-11-13 |
| 1932685385 | Carolyn Stewart | Nurse Practitioner | 3266 Bridge Walk Dr, Lawrenceville, GA 30044-5128 | 2018-07-18 |
| 1891236451 | Donnette Todd | Nurse Practitioner | 749 Flowers Xing, Lawrenceville, GA 30044-5954 | 2017-03-15 |
| 1952765869 | Johana M Ortiz | Nurse Practitioner | 1033 Gather Dr, Lawrenceville, GA 30043-7553 | 2016-04-06 |
| 1164885778 | Ablavi Agomessou | Nurse Practitioner | 881 Ivydale Ln, Lawrenceville, GA 30045-7818 | 2016-03-31 |
| 1205291028 | Lorraine Laplace | Nurse Practitioner | 2522 Cruse Rd Ste C2, Lawrenceville, GA 30044 | 2015-12-21 |
| Find all providers in LAWRENCEVILLE | ||||
| City | LAWRENCEVILLE |
| Zip Code | 30046 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.