Individual
KEVIN K BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2202 N JOHN B DENNIS HWY STE 100, KINGSPORT, TN 37660-5904
(423) 578-8500
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
148275
TN
363LF0000X
Family Nurse Practitioner
Primary
17873
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174957864
—
VA
05
—
Q008564
—
TN
Enumeration date
08/29/2013
Last updated
10/31/2023
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