Active NPI
Gracie Renee Blake
- Behavior Technician
- Van Buren, AR
National Provider Identifier
1083405757
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1109 Fayetteville Rd
Van Buren, AR 72956-3363 - Phone
- (479) 474-6444
- NPI assigned
- May 13, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
1109 Fayetteville Rd
Van Buren, AR 72956-3363
Mailing address
12822 Highway 217
Charleston, AR 72933-8005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| In-Sync Pediatric Therapy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Van Buren, AR
- NPI 1073704516
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1747094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747094400000",
"number": "1083405757",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12822 HIGHWAY 217",
"city": "CHARLESTON",
"state": "AR",
"postal_code": "729338005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1109 FAYETTEVILLE RD",
"city": "VAN BUREN",
"state": "AR",
"postal_code": "729563363",
"telephone_number": "479-474-6444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKE",
"first_name": "GRACIE",
"middle_name": "RENEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-13",
"last_updated": "2025-05-13",
"certification_date": "2025-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Van Buren, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.