Provider Demographics
NPI:1386635613
Name:BLAKEMAN, JAMIE DAWN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:DAWN
Last Name:BLAKEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-864-1472
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:426 COMMERCE DRIVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743
Practice Address - Country:US
Practice Address - Phone:270-932-2424
Practice Address - Fax:270-932-2522
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3267P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004439Medicaid
11221412OtherCAQH