Mandy Blake, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

5006329 Issued in NC

Practice address

129 Woodson St
Salisbury, NC 28144-3255

Phone

(704) 636-5576

Fax

(704) 216-2011

NPI assigned

Aug 6, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Terrie Hess Child Advocacy Center

  • Child Abuse Pediatrics Physician
  • Salisbury, NC
  • NPI 1639556004
  NPD (past)

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

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375747200000",
    "number": "1114359726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 WOODSON ST",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281443255",
            "telephone_number": "704-636-5576",
            "fax_number": "704-216-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 WOODSON ST",
            "city": "SALISBURY",
            "state": "NC",
            "postal_code": "281443255",
            "telephone_number": "704-636-5576",
            "fax_number": "704-216-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "MANDY",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-06",
        "last_updated": "2013-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5006329",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5006329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Binder Chiropractic Center P a
• William J Birmingham, M.D.
• William R Black, M.D.
• Wilbert Worth Blackman, DDS
• Leane Blais
• Heidi Yasmene Blaylock, FNP-C, ANP
• Blessing Hands in-Home Aide Services, LLC
• Blessing Hands in-Home Aide Services, LLC
• Jessica Ellen Blumenthal, MD
• Charles Boakye-Agyemang

• Pediatric Nurse Practitioner in Salisbury, NC
• Providers in Salisbury, NC by specialty
• Pediatric Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; 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.