Healthcare Provider Details

I. General information

NPI: 1548860471
Provider Name (Legal Business Name): LINDSAY BLAKE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LURAY DR
WINTERSVILLE OH
43953-3973
US

IV. Provider business mailing address

877 VISTA DR
GAHANNA OH
43230-5957
US

V. Phone/Fax

Practice location:
  • Phone: 740-314-8258
  • Fax:
Mailing address:
  • Phone: 740-275-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberLE00033349
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN376991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: