Provider Demographics
NPI:1184000234
Name:BLAYLOCK, RUBY AMANDA STIPE (PA-C)
Entity Type:Individual
Prefix:
First Name:RUBY AMANDA
Middle Name:STIPE
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:AMANDA
Other - Last Name:STIPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2146 BLOWING ROCK ROAD - APP URGENT CARE
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-265-5505
Mailing Address - Fax:828-265-5501
Practice Address - Street 1:2146 BLOWING ROCK ROAD - APP URGENT CARE
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-265-5505
Practice Address - Fax:828-265-5501
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC001006690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant