Individual
JESSICA CAROLE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1410 WILSON RD, NEWBERRY, SC 29108-3050
(803) 276-2186
(803) 276-2630
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
25430
SC
363L00000X
Nurse Practitioner
Primary
25430
SC
363LF0000X
Family Nurse Practitioner
25430
SC
Other
Enumeration date
10/01/2021
Last updated
01/07/2025
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