Individual
MRS. JILL ANN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3771 ROBERT C. BYRD DRIVE, BECKLEY, WV 25801
(304) 255-5710
(304) 255-5702
Mailing address
PO BOX 82, 109 DUFFY DRIVE, CRAB ORCHARD, WV 25827-0082
(304) 253-7408
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
45615
WV
Other
Enumeration date
10/17/2008
Last updated
10/17/2008
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