MEDICARE: KALA BLAKELY DNP, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	1-124159	AL
2	363LP2300X	Primary Care Nurse Practitioner	RN281139	GA
3	363LP2300X	Primary Care Nurse Practitioner	ARNP9465262	FL
4	363LP2300X	Primary Care Nurse Practitioner	221986	AZ

General Provider Information

NPI Number	:	1235428731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALA BLAKELY DNP, NP-C

Provider Business Mailing Address
First Line	:	2846 MOODY PKWY
Second Line	:	SUITE 300
City	:	MOODY
State	:	AL
Zip	:	35004-3328
Country	:	US
Telephone Number	:	205-640-1756
Fax Number	:	205-640-1796

Provider Business Practice Location Address
First Line	:	2846 MOODY PKWY STE 300
Second Line	:
City	:	MOODY
State	:	AL
Zip	:	35004-3328
Country	:	US
Telephone Number	:	205-640-1756
Fax Number	:	205-640-1796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	05/02/2024

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