Individual
MRS. COURTNEY L BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
520 MARY ST STE 520, EVANSVILLE, IN 47710-1682
(812) 424-8231
(812) 435-8794
Mailing address
520 MARY ST STE 520, EVANSVILLE, IN 47710-1682
(812) 424-8231
(812) 435-8794
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71012945A
IN
363LF0000X
Family Nurse Practitioner
Primary
71012945A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102619435
ANTHEM BCBS
IN
05
—
300066603
—
IN
05
—
7100861190
—
KY
01
—
71012945A
IN - LICENSE
IN
01
—
71012945C
CSR
IN
Enumeration date
07/25/2022
Last updated
03/05/2024
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