Provider Demographics
NPI:1285384701
Name:STEPHENS, BLAKE AUSTIN (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:AUSTIN
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 OLDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1720
Mailing Address - Country:US
Mailing Address - Phone:859-640-3310
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD STE 601
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5871
Practice Address - Country:US
Practice Address - Phone:704-355-7874
Practice Address - Fax:704-355-5619
Is Sole Proprietor?:No
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program