MS. KIMBERLY LORENE BLAKE FNP-C NPI 1689971749

NPI Information

MS. Kimberly Lorene Blake, FNP-C is a family nurse practitioner in Conway, AR with 14 years of experience. MS. Kimberly Lorene Blake, FNP-C NPI is 1689971749. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1125 SKYLINE DR
CONWAY, AR
ZIP 72032-657
Phone: (501) 358-6120
Fax: (501) 358-6268

The NPI 1689971749 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The CLIA number assigned to this NPI record is 04D1064840 - industrial with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/24/2011 and was last updated on 5/10/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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