Healthcare Provider Details

I. General information

NPI: 1508760943
Provider Name (Legal Business Name): AUSTIN BLAKEMAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ALLIANT AVE
JEFFERSONTOWN KY
40299-6372
US

IV. Provider business mailing address

1401 ALLIANT AVE
JEFFERSONTOWN KY
40299-6372
US

V. Phone/Fax

Practice location:
  • Phone: 502-267-1105
  • Fax:
Mailing address:
  • Phone: 502-267-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number149047
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: