Provider Demographics
NPI:1932674975
Name:STOKES, JUSTIN BLAKE (CRNP)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:BLAKE
Last Name:STOKES
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10075 GRAND BAY WILMER RD S
Mailing Address - Street 2:
Mailing Address - City:GRAND BAY
Mailing Address - State:AL
Mailing Address - Zip Code:36541-5003
Mailing Address - Country:US
Mailing Address - Phone:518-651-8522
Mailing Address - Fax:251-865-1854
Practice Address - Street 1:10075 GRAND BAY WILMER RD S
Practice Address - Street 2:
Practice Address - City:GRAND BAY
Practice Address - State:AL
Practice Address - Zip Code:36541-5003
Practice Address - Country:US
Practice Address - Phone:518-651-8522
Practice Address - Fax:251-865-1854
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-148285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily