Healthcare Provider Details

I. General information

NPI: 1225995657
Provider Name (Legal Business Name): BLAKE ATKINS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48439 GENESIS DR
COSHOCTON OH
43812-3204
US

IV. Provider business mailing address

6440 CLAY LITTICK DR
NASHPORT OH
43830-9520
US

V. Phone/Fax

Practice location:
  • Phone: 740-586-6282
  • Fax:
Mailing address:
  • Phone: 740-319-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0041158
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: