Healthcare Provider Details

I. General information

NPI: 1174439186
Provider Name (Legal Business Name): KERI BLAKE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WASHINGTON ST
MARIETTA OH
45750-1923
US

IV. Provider business mailing address

307 MAIN ST
BELPRE OH
45714-1613
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-6520
  • Fax: 740-374-6521
Mailing address:
  • Phone: 740-374-6520
  • Fax: 740-374-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number162213.MEDS-IV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: