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General NPI Number Information
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NPI Number | 1750973681
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Entity Type | Individual
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Provider Name | BLAKE KENT MCDANIEL FNP-C
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Gender | Male
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 808 W US HIGHWAY 79
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City | FRANKLIN
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State | TX
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Zip | 77856-1728
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Country | US
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Telephone | 979-828-1450
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Fax | 979-828-1164
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Provider Business Mailing Address
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Address Line | 808 W US HIGHWAY 79
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City | FRANKLIN
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State | TX
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Zip | 77856-1728
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Country | US
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Telephone | 979-828-1450
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Fax | 979-828-1164
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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 | 1029921
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License Number State | TX
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