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: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LRMC DEPARTMENT OF ANESTHESIOLOGY CMR 402
APO AE
09180
US

IV. Provider business mailing address

503 SYLVAN LANE P.O. BOX 190
MILL SPRING NC
28756
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 TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberTP929
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35590
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: