Active NPI
Kiarra Yaneth Marie Blakely-Russell
- Behavior Analyst
- Lakewood, WA
National Provider Identifier
1194207217
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BLAKEKY031CK
- Practice address
- 9320 112TH Street CT SW
Lakewood, WA 98498-2830 - Phone
- (253) 232-6079
- NPI assigned
- Sep 5, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 Analyst | 103K00000X | BLAKEKY031CK | WA | Primary |
Addresses
Primary practice location
9320 112TH Street CT SW
Lakewood, WA 98498-2830
Mailing address
9320 112TH Street CT SW
Lakewood, WA 98498-2830
Phone (253) 232-6079
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201678489WA | Medicaid | WA |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BLAKEKY031CK | WA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536105600000",
"number": "1194207217",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9320 112TH STREET CT SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984982830",
"telephone_number": "253-232-6079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9320 112TH STREET CT SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984982830",
"telephone_number": "253-232-6079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAKELY-RUSSELL",
"first_name": "KIARRA",
"middle_name": "YANETH MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-05",
"last_updated": "2018-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "WA",
"license": "BLAKEKY031CK",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201678489WA",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.