Individual
JESSICA ANN BANET BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
200 ABRAHAM FLEXNER WAY, LOUISVILLE, KY 40202-1886
(502) 367-3360
(502) 367-3365
Mailing address
100 E LIBERTY ST STE 800, LOUISVILLE, KY 40202-1428
(502) 587-4391
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3005563
KY
363LF0000X
Family Nurse Practitioner
3005563
KY
363LF0000X
Family Nurse Practitioner
71002575A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100115460
—
KY
Enumeration date
01/07/2008
Last updated
04/10/2018
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