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General NPI Number Information
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NPI Number | 1316651524
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Entity Type | Individual
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Provider Name | JENNIFER BLAYLOCK FNP
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Gender | Female
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 1010 S 3RD ST
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City | POLK CITY
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State | IA
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Zip | 50226-1130
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Country | US
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Telephone | 515-986-6426
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Fax |
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Provider Business Mailing Address
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Address Line | 15196 NW 16TH ST
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City | SLATER
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State | IA
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Zip | 50244-8019
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Country | US
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Telephone | 515-619-1475
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A172505
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | A172505
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License Number State | IA
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