Individual
SHAWNY JERRETTA BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCHIS
Contact information
Practice address
913B SAINT FRANCIS ST, KENNETT, MO 63857-1779
(573) 888-9881
Mailing address
913B SAINT FRANCIS ST, KENNETT, MO 63857-1779
(573) 888-9881
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
1003
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
401516
BLUE CROSS AND BLUE SHIELD
MO
Enumeration date
05/18/2009
Last updated
05/18/2009
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