MEDICARE: KRISTIN BLAKELY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	22955	CA

General Provider Information

NPI Number	:	1154752558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN BLAKELY PA-C

Provider Business Mailing Address
First Line	:	6055 BROOKDALE DR
Second Line	:
City	:	CARMEL
State	:	CA
Zip	:	93923-9549
Country	:	US
Telephone Number	:	831-250-8970
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 WASHINGTON ST
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-2409
Country	:	US
Telephone Number	:	831-372-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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