MEDICARE: LAUREN BLAKLEY APRN, FNP-BC

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	363LF0000X	Family Nurse Practitioner	25927	TN

General Provider Information

NPI Number	:	1326609074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BLAKLEY APRN, FNP-BC

Provider Business Mailing Address
First Line	:	2130 N CHARLES G SEIVERS BLVD STE 3
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-6705
Country	:	US
Telephone Number	:	865-264-4319
Fax Number	:

Provider Business Practice Location Address
First Line	:	2130 N CHARLES G SEIVERS BLVD STE 3
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-6705
Country	:	US
Telephone Number	:	865-264-4319
Fax Number	:	865-269-4556

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

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	09/18/2020

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