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NPI Code Detail

MEDICARE: JESSICA BLAKLEY DO

MEDICARE: JESSICA BLAKLEY DO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramAZ

General Provider Information

NPI Number : 1366382558
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BLAKLEY DO
Provider Business Mailing Address
First Line : 9202 N 2ND ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-2458
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9015 N 3RD ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85020-2444
Country : US
Telephone Number : 480-882-4545
Fax Number : 602-714-3755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2026
Last Update Date : 03/30/2026

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Directions to “ JESSICA BLAKLEY DO” Practice Location

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