Provider Demographics
NPI:1235428731
Name:BLAKELY, KALA (DNP, NP-C)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:DNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2846 MOODY PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3328
Mailing Address - Country:US
Mailing Address - Phone:205-640-1756
Mailing Address - Fax:205-640-1796
Practice Address - Street 1:2846 MOODY PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3328
Practice Address - Country:US
Practice Address - Phone:205-640-1756
Practice Address - Fax:205-640-1796
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9465262363LP2300X
AL1-124159363LA2200X
AZ221986363LP2300X
GARN281139363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care