Kiley Nicole Blakely, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95026091 Issued in CA

Practice address

12051 Bayport St Apt 1-106
Garden Grove, CA 92840-4430

Phone

(909) 680-2747

NPI assigned

Jul 31, 2023

Sex

Female

Sole proprietor

Yes

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

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": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1366123374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12051 BAYPORT ST APT 1-106",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404430",
            "telephone_number": "909-680-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12051 BAYPORT ST APT 1-106",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928404430",
            "telephone_number": "909-680-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKELY",
        "first_name": "KILEY",
        "middle_name": "NICOLE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95026091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynda M Bjornson, PHD
• Jessica Black
• Mia Blackburn
• Victor Blais, PH.D.
• Deanna Lynn Blake
• Emily Blank
• Jennifer Blank, MA
• Noah Anthony Blanks
• Reina Blean
• Sarina Blevins

• Family Nurse Practitioner in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; 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.