Kevin K Blake, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

17873 Issued in TN

Practice address

2202 N John B Dennis Hwy Ste 100
Kingsport, TN 37660-5904

Phone

(423) 578-8500

NPI assigned

Aug 29, 2013

Last updated

Oct 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

East Tennessee State University Quillen College of Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

WPS Providers IncGroup PAC ID 7719079532, 83 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indian Path Community Hospital Hospital, Kingsport, TN, CCN 440176
• Wellmont Holston Valley Medical Center Hospital, Kingsport, TN, CCN 440017

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• WPS Providers Inc

  • General Practice Physician
  • Kingsport, TN
  • NPI 1003904095
  Medicare reassignment Care Compare group
• Blue Ridge Medical Management Corporation

  dba First Assist Urgent Care

  • Urgent Care Clinic/Center
  • Elizabethton, TN
  • NPI 1144380833
  Medicare reassignment NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Neurological Surgery Physician
  • Johnson City, TN
  • NPI 1003152307
  NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• Solstas Lab Partners Group LLC

  • Clinical Medical Laboratory
  • Valdosta, GA
  • NPI 1407850985
  NPD (past)
• Wellmont Medical Associates Inc

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Abingdon, VA
  • NPI 1174808216
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mountain States Health Alliance

  dba Indian Path Community Hospital

  • General Acute Care Hospital
  • Kingsport, TN
  • NPI 1992813240
  Care Compare affiliation
• Wellmont Health System

  dba Holston Valley Medical Center

  • General Acute Care Hospital
  • Kingsport, TN
  • NPI 1487690400
  Care Compare affiliation

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

{
    "created_epoch": "1377734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1174957864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 N JOHN B DENNIS HWY STE 100",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605904",
            "telephone_number": "423-578-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Professional Park Dr",
            "address_2": "Suite 21",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046587",
            "country_code": "US",
            "telephone_number": "423-232-6900",
            "fax_number": "423-232-6903",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "378 Marketplace Blvd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042361",
            "country_code": "US",
            "telephone_number": "423-282-0751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "KEVIN",
        "middle_name": "K",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-29",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "148275",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "17873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q008564",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174957864",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• BKD Kingsport, LLC (Brookdale Kingsport)
• Amanda Blackburn, PHARMD
• Reid B Blackwelder, M.D.
• Gerald G Blackwell, MD
• Dottie S Blades, MSW LCSW
• Casey Jean Blakley, RPH
• Racheal Amanda Blakley, M.S OTR/L
• Kerri Elyse Blancarte, LPC
• Susan Montella Bland, M.D.
• Kaitlyn Ruthann Blankenbeckler, FNP

• Family Nurse Practitioner in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.