Healthcare Provider Details

I. General information

NPI: 1073620704
Provider Name (Legal Business Name): HEATHER ILENE BLOMELEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LRMC DEPARTMENT OF ANESTHESIOLOGY CMR 402
APO AE
09180
US

IV. Provider business mailing address

PO BOX 190
MILL SPRING NC
28756-0190
US

V. Phone/Fax

Practice location:
  • Phone: 496-371-9464
  • Fax:
Mailing address:
  • Phone: 828-894-8940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35590
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberTP929
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number74942
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: