Kevin Blakley, PSY.D.
Individual provider Active NPI Clinical Neuropsychologist · Elmendorf Afb, AK
NPI 1295794147 · NPPES record last updated Feb 11, 2009
Key facts
- NPI
- 1295794147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Neuropsychologist 103G00000X
- License
- 1742 (AZ)
- Practice address
- 5955 Zeamer Ave
Elmendorf Afb, AK 99506-3702 - Phone
- (907) 580-3114
- NPI assigned
- Mar 20, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1742 | AZ | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 1742 | AZ | Yes |
Addresses
Primary practice location
5955 Zeamer Ave
Elmendorf Afb, AK 99506-3702
Mailing address
5955 Zeamer Ave
Elmendorf Afb, AK 99506-3702
Phone (907) 580-3114
Other providers in Elmendorf Afb, AK
- Andrew A Beaulieu
- Kezia Bechtoldt
- Richard Benkovics
- Paul E Bennetts
- Heidi Louise Bjornes
- Dennis F. Bond II
- Kenneth Jerome Boomgaard
- Patricia Brady
- David Thomas Brown
- Eric Brown
All providers in Elmendorf Afb, AK · Clinical Neuropsychologist in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.