Provider Demographics
NPI:1003384496
Name:LAMKIN, BLAKE E (RD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:E
Last Name:LAMKIN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 LAKE BLVRD PO #40
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3811
Mailing Address - Country:US
Mailing Address - Phone:530-410-0147
Mailing Address - Fax:530-710-8388
Practice Address - Street 1:760 CYPRESS AVE STE 303
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2743
Practice Address - Country:US
Practice Address - Phone:530-410-0147
Practice Address - Fax:530-710-8388
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86108332133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered