KEVIN K BLAKE (NPI# 1174957864) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174957864 |
| Entity Type | Individual |
| Full Name | KEVIN K BLAKE |
| Credential | NP |
| Practice Address |
1 Professional Park Dr Suite 21 Johnson City TN 37604-6587 |
| Practice Telephone | 4232326900 |
| Practice Fax Number | 4232326903 |
| Mailing Telephone | 4232326900 |
| Mailing Fax Number | 4232326903 |
| Enumeration Date | 2013-08-29 |
| Last Update Date | 2017-01-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 148275 | TN | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
17873 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | Q008564 | 05 | |
| VA | 1174957864 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215394424 | Kevin Blake | Counselor | 4400 Euclid Ave, Cleveland, OH 44103-3734 | 2016-01-19 |
| 1114032133 | Kevin Michael Blake | Physical Therapist | 1893 Ne Miami Gardens Dr, North Miami Beach, FL 33179-5035 | 2006-08-20 |
| Street Address |
1 PROFESSIONAL PARK DR SUITE 21 |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-6587 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376548677 | Nancy G. Barbarito | Family Medicine | 1 Professional Park Dr, Ste 21, Johnson City, TN 37604-6589 | 2005-06-15 |
| 1063822773 | Julia E Davenport | Nurse Practitioner | 1 Professional Park Dr, Suite 21, Johnson City, TN 37604-6587 | 2014-05-02 |
| 1649578386 | Mountain States Health Alliance | Social Worker | 1 Professional Park Dr, Suite 21 Room C-17, Johnson City, TN 37604-6587 | 2011-03-04 |
| 1194040493 | Elnora Spradling | Internal Medicine | 1 Professional Park Dr, Suite 21, Johnson City, TN 37604-6587 | 2010-03-30 |
| 1275761538 | Blue Ridge Medical Management Corporation | Internal Medicine | 1 Professional Park Dr, Ste 21, Johnson City, TN 37604-6587 | 2009-06-25 |
| 1164677647 | Kimberly Michelle Arrowood | Nurse Practitioner | 1 Professional Park Dr, Suite 21, Johnson City, TN 37604-6587 | 2008-11-25 |
| 1992993760 | Kanishka Chakraborty | Internal Medicine | 1 Professional Park Dr, Suite 21, Johnson City, TN 37604-6587 | 2007-10-05 |
| 1326178138 | Melanie R. Harrison | Emergency Medicine | 1 Professional Park Dr, Suite 21, Johnson City, TN 37604-6587 | 2007-03-07 |
| 1619039948 | Mary Ann Cash | Nurse Practitioner | 1 Professional Park Dr, Suite 18, Johnson City, TN 37604-6587 | 2006-12-14 |
| 1144241464 | Koyamangalath Krishnan | Internal Medicine | 1 Professional Park Dr, Ste 21, Johnson City, TN 37604-6587 | 2006-07-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063025724 | Victoria Elizabeth Mcmanus | Nurse Practitioner | 365 Harry L Dr Ste 110, Johnson City, NY 13790-1471 | 2020-08-24 |
| 1649880139 | Amanda Danielle Ledford | Nurse Practitioner | 3 Enfield Ct, Johnson City, TN 37604-9101 | 2020-08-09 |
| 1861000135 | Deborah L Johnson | Nurse Practitioner | 2 Mcgregor Pl, Johnson City, TN 37604-1454 | 2020-07-22 |
| 1255978417 | William Mcguire | Nurse Practitioner | 176 Willocks Rd, Johnson City, TN 37601-6274 | 2019-12-06 |
| 1881248664 | Caiti Riden | Nurse Practitioner | 316 Marketplace Dr Ste 10, Johnson City, TN 37604-2595 | 2019-07-30 |
| 1699330282 | Courtney S Willis | Nurse Practitioner | 2203 N Greenwood Dr, Johnson City, TN 37604-7030 | 2019-05-08 |
| 1861955452 | Cindy Canter | Nurse Practitioner | 3552 Greenwood Dr, Johnson City, TN 37604-2834 | 2019-04-10 |
| 1366908980 | Holly Anne Parvin | Nurse Practitioner | 3209 W Walnut St, Johnson City, TN 37604-5949 | 2019-02-19 |
| 1891261376 | Lindsey Toney | Nurse Practitioner | 980 Smalling Rd, Johnson City, TN 37601-8208 | 2018-10-22 |
| 1821572868 | Karyn Kimberly Bruton | Nurse Practitioner | 1723 N Roan St, Johnson City, TN 37601-3949 | 2018-09-15 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
Please comment or provide details below to improve the information on KEVIN K BLAKE.
| 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.