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General NPI Number Information
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NPI Number | 1821703406
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Entity Type | Individual
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Provider Name | KAILEY BLAKENEY
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Gender | Female
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 01/18/2023
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Provider Practice Location Address
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Address Line | 1925 GLENN MITCHELL DR STE 206
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-0177
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Country | US
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Telephone | 757-507-0720
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Fax | 757-431-7319
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Provider Business Mailing Address
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Address Line | 940 PARKLAND LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-5220
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Country | US
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Telephone | 757-880-8223
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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 | 374700000X
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Taxonomy Name | Technician
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License Number | 1265000373
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License Number State | VA
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