MEDICARE: JOHN TRAVIS BLAKEMORE APRN

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	363L00000X	Nurse Practitioner	840749	NV

General Provider Information

NPI Number	:	1548837610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN TRAVIS BLAKEMORE APRN

Provider Business Mailing Address
First Line	:	PO BOX 100744
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-0744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 N TENAYA WAY STE 525
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0465
Country	:	US
Telephone Number	:	725-204-6520
Fax Number	:	702-441-7023

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

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	06/09/2025

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