MS. KIMBERLY LORENE BLAKE (NPI# 1689971749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689971749 |
| Entity Type | Individual |
| Full Name | MS. KIMBERLY LORENE BLAKE |
| Credential | FNP-C |
| Practice Address |
1125 Skyline Dr Conway AR 72032-6657 |
| Mailing Address |
1125 Skyline Dr Conway AR 72032-2857 |
| Practice Telephone | 5013586120 |
| Practice Fax Number | 5013586268 |
| Mailing Telephone | 5013586120 |
| Mailing Fax Number | 5013586268 |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2017-05-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
A03482 ANP | AR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689626319 | Kimberly A Blake | Nurse Practitioner | 106 Calvert St, Harrison, NY 10528-3131 | 2006-05-17 |
| 1790391530 | Kimberly Blake | Chore Provider | 1325 Airmotive Way, Reno, NV 89502-3201 | 2020-09-17 |
| 1811306418 | Kimberly Blake | Technician, Other | 815 W 5th North St, Morristown, TN 37814-3810 | 2014-08-07 |
| 1265715858 | Kimberly Blake | Case Manager/Care Coordinator | 6701 Hwy 67 S, Bldg 4, Benton, AR 72015 | 2011-09-21 |
| 1295030195 | Kimberly Thornton Blake | Physician Assistant | 1401 W Seminole Blvd, Sanford, FL 32771-6743 | 2011-01-24 |
| 1265480222 | Kimberly Blake | Obstetrics & Gynecology | 96 Colchester Ave, Burlington, VT 05401-1417 | 2006-05-04 |
| Street Address |
1125 SKYLINE DR |
| City | CONWAY |
| State | AR |
| Zip Code | 72032-6657 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043265655 | William C Pittman | Emergency Medicine | 1125 Skyline Dr, Conway, AR 72032-2857 | 2006-05-23 |
| 1730605213 | Rhonda K Begley | Nurse Practitioner | 1125 Skyline Dr, Conway, AR 72032-2857 | 2017-08-16 |
| 1528466778 | Pittman Group | General Practice | 1125 Skyline Dr, Conway, AR 72032-2857 | 2014-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730789843 | Amelia S Lasater | Pharmacist | 1155 Hwy 65n, Conway, AR 72032 | 2020-10-28 |
| 1619584604 | Danyelle Durocher | Occupational Therapist | 1301 North Museum Rd, Conway, AR 72032 | 2020-09-24 |
| 1780222174 | Eric Herman Boxnick | Pharmacist | 101 West Oak Street, Conway, AR 72032 | 2019-12-16 |
| 1932746070 | Habilitation Center, LLC | Psychiatric Residential Treatment Facility | 161 Skunk Hollow Road, Conway, AR 72032 | 2019-12-09 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1275035602 | Conway Dental Center Pllc | Dentist | 1600 E. Oak Street Suite B, Conway, AR 72032 | 2018-03-01 |
| 1750821625 | Luke Osborne | Physical Therapy Assistant | 1 Thomas Ln, Conway, AR 72032 | 2017-02-27 |
| 1639620099 | Sam's West, Inc. | Technician/Technologist | 1250 South Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1922559343 | Sam's West, Inc. | Durable Medical Equipment & Medical Supplies | 1250 Sourth Amity Rd, Conway, AR 72032 | 2016-10-20 |
| 1639629108 | Posture Store | Durable Medical Equipment & Medical Supplies | 3900 Dave Ward Dr., Suite 1900-130, Conway, AR 72032 | 2016-10-09 |
| Find all providers in zip 72032 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023617594 | Mckenzie Lauren Cotton | Nurse Practitioner | 1065 Skyline Dr, Conway, AR 72032-3530 | 2020-10-25 |
| 1316566607 | Shannon Busby | Nurse Practitioner | 1505 Winterbrook Dr, Conway, AR 72034-3564 | 2020-04-16 |
| 1538798087 | Glenda Darlene Gore | Nurse Practitioner | 17 Kali Ct, Conway, AR 72032-9477 | 2020-04-06 |
| 1265071427 | Dana Aysha Niederhauser | Nurse Practitioner | 1250 Littlewood Cv, Conway, AR 72032-8986 | 2020-01-04 |
| 1285287680 | Joy Griffith | Nurse Practitioner | 2907 Percy Cir, Conway, AR 72034-5508 | 2019-07-24 |
| 1366094260 | Kerry Kathryn Lewis | Nurse Practitioner | 1910 Royal Dr, Conway, AR 72034-7346 | 2019-07-10 |
| 1487113148 | Laura B Kelly | Nurse Practitioner | 2300 Linda Dr, Conway, AR 72032-8999 | 2019-03-12 |
| 1780141069 | Ashleigh Lynn Kinon | Nurse Practitioner | 2065 Woodlawn Dr, Conway, SC 29526-7703 | 2019-02-22 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1780191015 | Sydnie Thessing | Nurse Practitioner | 605 Dave Ward Drive #105, Conway, AR 72034 | 2018-01-09 |
| Find all providers in CONWAY | ||||
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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.