Individual
MONICA V BLAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
605 STADIUM DR, HATTIESBURG, MS 39401-4156
(601) 450-0310
(601) 450-0321
Mailing address
PO BOX 511, HATTIESBURG, MS 39403-0511
(601) 450-0310
(601) 450-0321
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R872218
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04157249
—
MS
01
—
12131306
CAQH ID
MS
01
—
9971504
AETNA PIN
MS
Enumeration date
05/28/2010
Last updated
07/08/2011
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