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NPI Code Detail

MEDICARE: MS. CAROL WARREN BLAKEMORE MBA, LCSW, APRN, BC

MEDICARE: MS. CAROL WARREN BLAKEMORE MBA, LCSW, APRN, 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
11041C0700XClinical Social Worker667TN
2163WP0809XAdult Psychiatric/Mental Health Registered Nurse67375TN
3364SP0809XAdult Psychiatric/Mental Health Clinical Nurse SpecialistTN

General Provider Information

NPI Number : 1598752792
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROL WARREN BLAKEMORE MBA, LCSW, APRN, BC
Provider Business Mailing Address
First Line : 9160 VALLEY GROVE LN
Second Line :
City : SOUTHAVEN
State : MS
Zip : 38671-9107
Country : US
Telephone Number : 662-393-5671
Fax Number :
Provider Business Practice Location Address
First Line : 920 MADISON
Second Line : STE. 507
City : MEMPHIS
State : TN
Zip : 38163-0001
Country : US
Telephone Number : 901-448-1584
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 09/11/2025

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