Provider Demographics
NPI:1932711058
Name:BARNETT, BLAKELEE BROCK (APRN)
Entity type:Individual
Prefix:MS
First Name:BLAKELEE
Middle Name:BROCK
Last Name:BARNETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 W CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2376
Mailing Address - Country:US
Mailing Address - Phone:606-499-0205
Mailing Address - Fax:
Practice Address - Street 1:2004 CUMBERLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1385
Practice Address - Country:US
Practice Address - Phone:606-248-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012948363LF0000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife