Individual
KENT WILLIAM BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
675 BALTIMORE DR, WILKES BARRE, PA 18702-7900
(800) 275-6401
Mailing address
14324 52ND AVE W UNIT B, EDMONDS, WA 98026-3803
(425) 951-0704
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
G162755
CA
207RR0500X
Rheumatology Physician
MD042525L
PA
207RR0500X
Rheumatology Physician
Primary
MD60640236
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD042525L
STATE LICENSE
PA
01
—
MD60640236
STATE LICENSE
WA
01
—
MED-PHYS-COM-LIC-112
STATE LICENSE
MT
Enumeration date
09/06/2006
Last updated
02/09/2026
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