Provider Demographics
NPI:1508543141
Name:BLAKEMORE, ALLYSON MICHELLE (APRN AG-ACNP)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MICHELLE
Last Name:BLAKEMORE
Suffix:
Gender:F
Credentials:APRN AG-ACNP
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:HAMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 LARCHWAY LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9751
Mailing Address - Country:US
Mailing Address - Phone:812-701-5066
Mailing Address - Fax:
Practice Address - Street 1:3535 PENTAGON BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-1705
Practice Address - Country:US
Practice Address - Phone:937-702-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034282363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care