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General NPI Number Information
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NPI Number | 1639620941
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Entity Type | Individual
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Provider Name | BLAKLEY T STONE CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 10415 WALLACE ALLEY ST
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City | KINGSPORT
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State | TN
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Zip | 37663-3936
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Country | US
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Telephone | 423-390-0451
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Fax | 423-844-2688
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Provider Business Mailing Address
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Address Line | 105 W STONE DR SUITE 6A
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City | KINGSPORT
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State | TN
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Zip | 37660-3365
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Country | US
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Telephone | 423-408-7220
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Fax | 423-408-7405
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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 | 0001237944
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 22265
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License Number State | TN
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