Provider Demographics
NPI:1346751013
Name:BLAKLEY, REBECCA JEANNINE (CPNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEANNINE
Last Name:BLAKLEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEANNINE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 HOSPITAL WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1872
Mailing Address - Country:US
Mailing Address - Phone:606-451-2756
Mailing Address - Fax:
Practice Address - Street 1:350 HOSPITAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1872
Practice Address - Country:US
Practice Address - Phone:865-207-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2020-11-14
Deactivation Date:2018-07-25
Deactivation Code:
Reactivation Date:2018-07-26
Provider Licenses
StateLicense IDTaxonomies
KY3014537208000000X
TN23410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN23410OtherADVANCED PRACTICE REGISTERED NURSE