Individual
CHRISTY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1400 COULTER, AMARILLO, TX 79106-1786
(806) 354-5630
(806) 354-5689
Mailing address
1400 WALLACE BLVD, ATTN: CREDENTIALING, AMARILLO, TX 79106-1708
(806) 354-5585
(806) 356-4673
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
234120
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
089409901
—
TX
05
—
100186480A
—
OK
05
—
S8769
—
NM
Enumeration date
07/07/2006
Last updated
06/05/2009
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