Healthcare Provider Details

I. General information

NPI: 1356603906
Provider Name (Legal Business Name): KARA BLAKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1894 WALTON AVE
BRONX NY
10453-6018
US

IV. Provider business mailing address

1894 WALTON AVE
BRONX NY
10453-6018
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-3060
  • Fax:
Mailing address:
  • Phone: 718-583-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF356628-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: