Individual
MR. JACOB ELISHA RAY BLEVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
101 ORCHARD DR, NICHOLASVILLE, KY 40356-2690
(859) 881-4288
(859) 881-4388
Mailing address
215 E 11TH ST, NEWPORT, KY 41071-2203
(859) 655-6100
(859) 655-6241
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4052853
KY
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
KY
Other
Enumeration date
01/22/2026
Last updated
03/24/2026
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