Individual
BLAKE TIMOTHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6019 WALNUT GROVE RD, MEMPHIS, TN 38120-2113
(901) 226-5000
Mailing address
1619 WOLF RIDGE DR, COLLIERVILLE, TN 38017-8684
(435) 862-9852
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
287889
TN
Other
Enumeration date
10/13/2025
Last updated
10/13/2025
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