Provider Demographics
NPI:1588387047
Name:FINE, BLAKLEY ALEXANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:BLAKLEY
Middle Name:ALEXANDRA
Last Name:FINE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9100 STONEY MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2094
Mailing Address - Country:US
Mailing Address - Phone:423-432-3378
Mailing Address - Fax:
Practice Address - Street 1:2415 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3322
Practice Address - Country:US
Practice Address - Phone:423-624-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant