Healthcare Provider Details

I. General information

NPI: 1215239595
Provider Name (Legal Business Name): NES WASHINGTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TONGASS AVE
KETCHIKAN AK
99901
US

IV. Provider business mailing address

7300 STATE HIGHWAY 121 STE 370-374
MCKINNEY TX
75070-1987
US

V. Phone/Fax

Practice location:
  • Phone: 907-225-5171
  • Fax:
Mailing address:
  • Phone: 469-557-6183
  • Fax: 469-640-6671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BLAKEMAN
Title or Position: PROVIDER ENROLLMENT
Credential:
Phone: 469-557-6183