Canaan Blake, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

280433 Issued in NC

Practice address

2511 Old Cornwallis Rd
Suite 200
Durham, NC 27713-1869

Phone

(919) 932-5700

Fax

(919) 933-6881

NPI assigned

Dec 18, 2015

Sex

Male

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 HI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• University Clinical Education & Research Associates

  • Specialist
  • Honolulu, HI
  • NPI 1013966845
  Medicare reassignment NPD
• University Clinical Education & Research Associates

  • Clinical Medical Laboratory
  • Honolulu, HI
  • NPI 1659971489
  NPD

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

{
    "created_epoch": "1450396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450396800000",
    "number": "1407211329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 OLD CORNWALLIS RD",
            "address_2": "SUITE 200",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277131869",
            "telephone_number": "919-932-5700",
            "fax_number": "919-933-6881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 OLD CORNWALLIS RD",
            "address_2": "SUITE 200",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277131869",
            "telephone_number": "919-932-5700",
            "fax_number": "919-933-6881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CANAAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-18",
        "last_updated": "2015-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "280433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Blackwell, PA-C
• Ainsley Marie Blackwood
• Lindsey Crist Blackwood
• Hayden Blaine, MSW, LCSWA
• Jersey Blair
• Pashyon N Blake, MSW, LCSWA
• Stephanie McCallum Blake, MSN, NNP-BC
• Thomas Matthew Blakemore, PA-C
• Shannon Blakey, PHD
• Daniel Vanhoy Blalock, PHD

• Nurse Practitioner in Durham, NC
• Providers in Durham, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; 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.