Individual
JESSICA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15101 GLENWOOD AVE, STANLEY, KS 66223
(913) 681-8866
Mailing address
15101 GLENWOOD AVE, STANLEY, KS 66223-3154
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
109445
KS
363L00000X
Nurse Practitioner
Primary
53-76586
KS
Other
Enumeration date
09/18/2014
Last updated
07/25/2018
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