Rebecca S Blake I, CNA

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

37V350170804 Issued in OK

Practice address

408 S 17TH St
Clinton, OK 73601-4236

Phone

(580) 323-0312

NPI assigned

Jul 1, 2008

Last updated

Jul 22, 2008By the provider in NPPES

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

Other names 1

• Mrs. Rebecca S Blake I Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216684800000",
    "number": "1205098134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 N MO ST",
            "city": "THOMAS",
            "state": "OK",
            "postal_code": "73369",
            "telephone_number": "580-661-2904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 S 17TH ST",
            "city": "CLINTON",
            "state": "OK",
            "postal_code": "736014236",
            "telephone_number": "580-323-0312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "REBECCA",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "name_suffix": "I",
        "credential": "CNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2008-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OK",
            "license": "37V350170804",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "OK",
            "license": "37V350170804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REBECCA",
            "last_name": "BLAKE",
            "middle_name": "S",
            "prefix": "MRS.",
            "suffix": "I",
            "credential": "CERTIFIED NURSE AID",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Barbara Benally, LPN
• Robert Bennett
• Melanie N Benson
• Michelle Marie Beshaw, PA-C
• Donna Sue Blake, RN
• Cameron Blevins
• Julie Denise Boese, D.PH.
• David Lynn Boone, D.D.S.
• Namen Bouma
• Kimberlynn Bownds, RN

• Community Health Worker in Clinton, OK
• Providers in Clinton, OK by specialty
• Community Health Worker in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.