Jennifer Stewart Blakely Lou, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

9605 Issued in TN

Practice address

875 Union Ave
Department of Pediatric Dentistry
Memphis, TN 38103-3513

Phone

(901) 448-6260

Fax

(901) 448-3817

NPI assigned

Jun 18, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Jennifer Stewart Blakely Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392595200000",
    "number": "1033370457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 UNION AVE",
            "address_2": "DEPARTMENT OF PEDIATRIC DENTISTRY",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033513",
            "telephone_number": "901-448-6260",
            "fax_number": "901-448-3817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 UNION AVE",
            "address_2": "DEPARTMENT OF PEDIATRIC DENTISTRY",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381033513",
            "telephone_number": "901-448-6260",
            "fax_number": "901-448-3817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOU",
        "first_name": "JENNIFER",
        "middle_name": "STEWART BLAKELY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-18",
        "last_updated": "2014-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "VA",
            "license": "0401413498",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "9605",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AR",
            "license": "3921",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BLAKELY",
            "middle_name": "STEWART",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jesus Lopez
• Kito Akin Lord, M.D.
• India Lott
• Jessi Lott
• Lotts of Love Helping Hands,LLC
• Magda Lou
• Phillip Louder
• Emily May Louie
• Louis Valentine Eberle III
• Domonique Louis, PMHNP-BC

• Pediatric Dentistry in Memphis, TN
• Providers in Memphis, TN by specialty
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.