BLAKE ADAM GLYNN (NPI# 1891283842) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891283842 |
| Entity Type | Individual |
| Full Name | BLAKE ADAM GLYNN |
| Credential | PA-C |
| Practice Address |
Blanchfield Army Community Hospital 650 Joel Drive Fort Campbell KY 42223 |
| Mailing Address |
4430 Missouri Ave Fort Leonard Wood MO 65473-9098 |
| Practice Telephone | 2707988400 |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2018-12-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4430 Missouri Ave, Fort Leonard Wood, MO 654739098 | 5735960422 |
| Street Address |
BLANCHFIELD ARMY COMMUNITY HOSPITAL 650 JOEL DRIVE |
| City | FORT CAMPBELL |
| State | KY |
| Zip Code | 42223 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992776991 | Gordon Troy Prairie | Family Medicine | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223 | 2006-01-28 |
| 1477181428 | Aaron Alan Hardy | Physician Assistant | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223 | 2020-03-27 |
| 1598390452 | Raymond L. Hernandez | Physician Assistant | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223-5349 | 2020-03-11 |
| 1053801886 | Mark Leon Siebe | Family Medicine | Blanchfield Army Community Hospital, 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2018-05-17 |
| 1407363575 | Sean Patrick Casey Stewart | Pharmacist | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223 | 2018-01-10 |
| 1871020081 | Marquita Sheree Barr | Social Worker | Blanchfield Army Community Hospital, 650 Joel Dr, Fort Campbell, KY 42223-5349 | 2017-05-18 |
| 1346776465 | Curtiss Mills | Family Medicine | Blanchfield Army Community Hospital, 650 Joel Dr, Fort Campbell, KY 42223 | 2017-05-10 |
| 1497295240 | Sarahlouise Perez | Counselor | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223 | 2017-02-27 |
| 1134675481 | Joseph Flynn Drevlow | Physician Assistant | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223 | 2016-08-28 |
| 1700236866 | Carolyn Printz | Social Worker | Blanchfield Army Community Hospital, 650 Joel Dr, Fort Campbell, KY 42223-5349 | 2016-06-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558978825 | Eden Addisu Kebede | Social Worker | Ft. Campbell/bach, 650 Joel Drive, Fort Campbell, KY 42223 | 2020-09-30 |
| 1174134662 | Lucas Pepper | Dentist | Desert Storm Ave, Bldg 5580, Apo, AA 42223 | 2020-08-10 |
| 1639711203 | Travis Robert Bryant | Optometrist | 5979 Desert Storm Ave., Lapointe Health Clnic Optometry, Ft. Campbell, KY 42223 | 2019-10-15 |
| 1184138232 | Vanessa Renee Simmons | Dental Assistant | 302b Baker St, Fort Campbell, KY 42223 | 2017-11-28 |
| 1922451996 | Isabella Julson | Dental Assistant | Bldg2441 21st Street, Us Army Dental Activity, Fort Campbell, KY 42223 | 2016-07-14 |
| 1336595305 | Heidi Cameron | Acupuncturist | 2889b Idaho Avenue, Fort Campbell, KY 42223 | 2016-05-10 |
| 1649644154 | Nathan Silvey | Physician Assistant | Building 4179, Fort Campbell, KY 42223 | 2015-11-20 |
| 1396145306 | Blanchfield Army Community Hospital | Clinic/Center | Bldg 2403, Air Assault St and Indiana Ave, Fort Campbell, KY 42223 | 2014-08-27 |
| 1275948564 | Rodney C Merkley | Psychologist | Building 3929, Ft. Capmbell, KY 42223 | 2014-06-25 |
| 1659785053 | Blanchfield Army Community Hospital | Clinic/Center | Bldg 6747 A Shau Valley Road, Fort Campbell, KY 42223 | 2014-06-13 |
| Find all providers in zip 42223 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649644154 | Nathan Silvey | Physician Assistant | Building 4179, Fort Campbell, KY 42223 | 2015-11-20 |
| 1962794172 | Brian M Wills | Physician Assistant | 650 Joel Drvie, Fort Campbell, KY 42223 | 2011-05-05 |
| 1861716524 | Lucas Benjamin Barker | Physician Assistant | Building 7149 Blacksheep Run Rd, Fort Campbell, KY 42223-5318 | 2010-03-23 |
| 1386879005 | David Lee Driskell | Physician Assistant | 6768 Desert Storm Ave, Hhc 3-187th In Regt, Fort Campbell, KY 42223 | 2009-05-26 |
| 1336343698 | Carrie Renee Smith | Physician Assistant | 650 Joel Dr Rm 1be01, Fort Campbell, KY 42223-5318 | 2007-06-12 |
| 1821101460 | Michael Joe Burns Jr. | Physician Assistant | Building 5979 Deset Storm Avenue, Ashau Valley Clinic, Fort Campbell, KY 42223 | 2006-08-17 |
| 1568063519 | Jeremy Schadewald | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-11-05 |
| 1487262408 | John William Zamora | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-15 |
| 1295343218 | Joshua Ryan Agard | Physician Assistant | 650 Joel Dr, Fort Campbell, KY 42223-5318 | 2020-07-15 |
| 1477181428 | Aaron Alan Hardy | Physician Assistant | Blanchfield Army Community Hospital, 650 Joel Drive, Fort Campbell, KY 42223 | 2020-03-27 |
| Find all providers in FORT CAMPBELL | ||||
| City | FORT CAMPBELL |
| Zip Code | 42223 |
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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.