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General NPI Number Information
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NPI Number | 1548837610
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Entity Type | Individual
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Provider Name | JOHN TRAVIS BLAKEMORE APRN
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Gender | Male
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 3150 N TENAYA WAY STE 525
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City | LAS VEGAS
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State | NV
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Zip | 89128-0465
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Country | US
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Telephone | 725-204-6520
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Fax | 702-441-7023
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Provider Business Mailing Address
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Address Line | PO BOX 100744
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City | ATLANTA
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State | GA
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Zip | 30384-0744
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 840749
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License Number State | NV
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