Tisha Blakeley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

5046 Issued in KY

Practice address

735 North Dr
Hopkinsville, KY 42240-2620

Phone

(270) 886-5163

Fax

(270) 886-5178

NPI assigned

Jan 10, 2014

Last updated

Feb 19, 2016By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Lifeskills, Inc.

  • Community/Behavioral Health Agency
  • Bowling Green, KY
  • NPI 1669401816
  Medicare reassignment NPD

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

{
    "created_epoch": "1389312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455840000000",
    "number": "1295157238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 614",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422410614",
            "telephone_number": "270-886-2205",
            "fax_number": "270-886-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 NORTH DR",
            "city": "HOPKINSVILLE",
            "state": "KY",
            "postal_code": "422402620",
            "telephone_number": "270-886-5163",
            "fax_number": "270-886-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKELEY",
        "first_name": "TISHA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-01-10",
        "last_updated": "2016-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "5046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabella Blu Binion
• Allison Nicole Birak
• Allison Ann Bivins
• Katrena Blackwell, MSN, PMHCNS, ARNP-BC
• Sharon Blaine
• Blanks, LLC
• Patricia Ann Blewett, M.D.
• Haley Austin Midkiff Blue, ATC,LAT
• Bluegrass Sleep Disorders Center
• Rebecca L Boggess, APRN

• Clinical Social Worker in Hopkinsville, KY
• Providers in Hopkinsville, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.