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General NPI Number Information
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NPI Number | 1245765841
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Entity Type | Individual
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Provider Name | CHRISTINA L BLAKE NP
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Gender | Female
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 106 W GEORGIA RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2302
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Country | US
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Telephone | 864-662-6840
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Fax | 864-448-1720
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Provider Business Mailing Address
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Address Line | 106 W GEORGIA RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2302
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Country | US
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Telephone | 864-662-6840
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Fax | 864-448-1720
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 225614
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 211071
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 21071
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License Number State | SC
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