Kelley E Blake (NPI# 1770737249, PAC ID# 4981768694) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1770737249 |
| PAC ID by PECOS | 4981768694 |
| Professional Enrollment ID | I20151201003172 |
| Full Name | Kelley E Blake |
| Organization Legal Name | WIREGRASS CLINIC LLC |
| Address |
4300 W Main St Dothan AL 36305-1058 |
| Gender | F |
| Graduation Year | 2008 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 2860662491 |
| Number of Group Practice Members | 37 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 010055 | FLOWERS HOSPITAL |
| 010021 | DALE MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 4300 W Main St, Dothan, AL 36305-1058 | WIREGRASS CLINIC LLC | |
| 4300 W Main St, Suite 45, Dothan, AL 36305-1317 | 3349447095 | WIREGRASS CLINIC LLC |
| 1412 Elba Hwy, Troy, AL 36079-6020 | 3345668822 | SOUTHEAST ALABAMA RURAL HEALTH ASSOCIATES |
| Organization Legal Name | WIREGRASS CLINIC LLC |
| Physicians | 37 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Meaghan S Taylor | Nurse Practitioner | Wiregrass Clinic LLC | 2910 Hospital Dr, Bonifay, FL 32425-4268 |
| Ivan D Jackson | Internal Medicine | Wiregrass Clinic LLC | 210 Westside Dr, Dothan, AL 36303-1928 |
| Jennifer M Parrish | Nurse Practitioner | Wiregrass Clinic LLC | 348 Healthwest Dr, Dothan, AL 36303-1907 |
| Emily Jones | Family Medicine | Wiregrass Clinic LLC | 108 Medical Dr, Dothan, AL 36303-6902 |
| Samantha P Carter | Nurse Practitioner | Wiregrass Clinic LLC | 4300 W Main St, Suite 16, Dothan, AL 36305-1310 |
| Charles J Carpenter Jr. | General Surgery | Wiregrass Clinic LLC | 4370 W Main St, Dothan, AL 36305-1056 |
| J. Douglas Duke Ii | General Surgery | Wiregrass Clinic LLC | 4370 W Main St, Dothan, AL 36305-1056 |
| Jason Lee Cox | Nurse Practitioner | Wiregrass Clinic LLC | 4300 W Main St, Suite 21, Dothan, AL 36305-1058 |
| Tina Cochran | Nurse Practitioner | Wiregrass Clinic LLC | 4300 W Main St, Suite 41, Dothan, AL 36305-1318 |
| John J Marsella Jr. | Anesthesiology | Wiregrass Clinic LLC | 4300 W Main St, Suite 405, Dothan, AL 36305-1086 |
| Street Address |
4300 W MAIN ST |
| City | DOTHAN |
| State | AL |
| Zip | 36305-1058 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Parks W Pratt Iii | Rheumatology | 4300 W Main St, Suite 102, Dothan, AL 36305-1306 | |
| Samantha P Carter | Nurse Practitioner | Wiregrass Clinic LLC | 4300 W Main St, Suite 16, Dothan, AL 36305-1310 |
| Chelsey Jane Smith | Otolaryngology | Dothan Ent Associates, P.C. | 4300 W Main St, Suite 403, Dothan, AL 36305-4001 |
| Emily E Cannon | General Surgery | Wiregrass Surgical Associates, P.C. | 4300 W Main St, Suite 24, Dothan, AL 36305-1312 |
| Paul C Motta | Allergy/immunology | Dothan Ent Associates, P.C. | 4300 W Main St, Suite 403, Dothan, AL 36305-4001 |
| Bradley T Marker | General Surgery | Wiregrass Surgical Associates, P.C. | 4300 W Main St, Suite 24, Dothan, AL 36305-1312 |
| Norma Faye Mcknight | Nurse Practitioner | Affiliated Dermatology, PC | 4300 W Main St, Suite 102, Dothan, AL 36305-1051 |
| Kelli N Heer | Physician Assistant | Affiliated Dermatology, PC | 4300 W Main St, Suite 102, Dothan, AL 36305-1051 |
| Roger J Williams | Urology | Wiregrass Urology, PC | 4300 W Main St, Suite 102, Dothan, AL 36305-1306 |
| Jason Lee Cox | Nurse Practitioner | Wiregrass Clinic LLC | 4300 W Main St, Suite 21, Dothan, AL 36305-1058 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Robert M Hagler | Obstetrics/gynecology | Womens Healthcare of Dothan PC | Suite, 31 4300 W Main St, Dothan, AL 36305-1051 |
| Tonia L Ruddock | Dermatology | Affiliated Dermatology, PC | 4300 W Main St, Suite 102, Dothan, AL 36305-1051 |
| Laura M Tamburin | Dermatology | Affiliated Dermatology, PC | 4300 W Main St, Suite 102, Dothan, AL 36305-1051 |
| Candace N Short | Nurse Practitioner | Womens Healthcare of Dothan PC | Suite, 31 4300 W Main St, Dothan, AL 36305-1051 |
| James Butler | Obstetrics/gynecology | Womens Healthcare of Dothan PC | Suite, 31 4300 W Main St, Dothan, AL 36305-1051 |
| Craig D Omohundro | Dermatology | Affiliated Dermatology, PC | 4300 W Main St, Suite 102, Dothan, AL 36305-1051 |
| Philip Mathew Dozier | Obstetrics/gynecology | Womens Healthcare of Dothan PC | Suite, 31 4300 W Main St, Dothan, AL 36305-1051 |
| Christopher E Nicholls | Obstetrics/gynecology | Womens Healthcare of Dothan PC | Suite, 31 4300 W Main St, Dothan, AL 36305-1051 |
| Deborah M Helms | Physician Assistant | Womens Healthcare of Dothan PC | Suite, 31 4300 W Main St, Dothan, AL 36305-1051 |
| Bryan C Mullins | Obstetrics/gynecology | Womens Healthcare of Dothan PC | Suite, 31 4300 W Main St, Dothan, AL 36305-1051 |
| Find all physicians in zip 36305 | |||
| City | DOTHAN |
| Zip Code | 36305 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | DOTHAN + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Kelley E Blake.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.