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General NPI Number Information
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NPI Number | 1982495453
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Entity Type | Individual
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Provider Name | TYLETTA MARSHBANKS BLAKELY
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Gender | Female
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 2601 LITTLE ELM PKWY STE 1803
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City | LITTLE ELM
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State | TX
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Zip | 75068-2503
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Country | US
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Telephone | 214-724-4682
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 LAKE POINT CT
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City | LITTLE ELM
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State | TX
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Zip | 75068-8428
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 20701
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | TX
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