Individual
KORI BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1107 GLEN DALE HEIGHTS RD, GLEN DALE, WV 26038-1092
(304) 281-4344
Mailing address
1107 GLEN DALE HEIGHTS RD, GLEN DALE, WV 26038-1092
(304) 281-4344
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
12/12/2023
Last updated
12/12/2023
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