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General NPI Number Information
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NPI Number | 1306647722
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Entity Type | Individual
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Provider Name | BLAKE PAUL WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 801 POLE LINE RD W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5810
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Country | US
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Telephone | 208-814-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 420 CAYUSE CREEK DR
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City | KIMBERLY
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State | ID
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Zip | 83341-5133
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Country | US
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Telephone | 801-979-5040
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3671263
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License Number State | ID
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