Individual
KIMBERLY A BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
106 CALVERT ST, HARRISON, NY 10528-3131
(914) 835-0073
(914) 835-1071
Mailing address
106 CALVERT ST, HARRISON, NY 10528-3131
(914) 241-1050
(914) 242-1516
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
F302529
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02073710
—
NY
01
—
0667910001
DME
NY
Enumeration date
05/17/2006
Last updated
01/21/2020
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