Provider Demographics
NPI:1467636589
Name:BLAKEY, IESHIA MIYA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:IESHIA
Middle Name:MIYA
Last Name:BLAKEY
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 1:2215 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212-1033
Mailing Address - Country:US
Mailing Address - Phone:502-774-8631
Mailing Address - Fax:502-772-8189
Practice Address - Street 1:1000 NEIGHBORHOOD PL
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:KY
Practice Address - Zip Code:40118-9697
Practice Address - Country:US
Practice Address - Phone:502-361-2381
Practice Address - Fax:502-996-8309
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100263420Medicaid
KYK088790Medicare PIN
KYK088792Medicare PIN
KYK088793Medicare PIN
KYK088796Medicare PIN
KYK088791Medicare PIN
KYK088794Medicare PIN
KYK088795Medicare PIN