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NPI Code Detail

MEDICARE: BLAKELYNN BRAKE QBHP

MEDICARE: BLAKELYNN BRAKE QBHP
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1679338792
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKELYNN BRAKE QBHP
Provider Business Mailing Address
First Line : PO BOX 11818
Second Line :
City : FORT SMITH
State : AR
Zip : 72917-1818
Country : US
Telephone Number : 479-452-6650
Fax Number : 479-452-5847
Provider Business Practice Location Address
First Line : 3111 S 70TH ST
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-5017
Country : US
Telephone Number : 479-452-6650
Fax Number : 457-452-5847
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2024
Last Update Date : 03/02/2026

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