Healthcare Provider Details

I. General information

NPI: 1235428731
Provider Name (Legal Business Name): KALA BLAKELY DNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2846 MOODY PKWY STE 300
MOODY AL
35004-3328
US

IV. Provider business mailing address

2846 MOODY PKWY SUITE 300
MOODY AL
35004-3328
US

V. Phone/Fax

Practice location:
  • Phone: 205-640-1756
  • Fax: 205-640-1796
Mailing address:
  • Phone: 205-640-1756
  • Fax: 205-640-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-124159
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN281139
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9465262
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number221986
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: