Sheila D Blake, RN, MNS,CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

21932 Issued in GA

Practice address

1045 Southcrest Dr
Suite 110
Stockbridge, GA 30281-6113

Phone

(770) 507-2212

Fax

(770) 507-2213

NPI assigned

Mar 16, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

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.

• Kids First Pediatric Group, LLC

  • Pediatrics Physician
  • Stockbridge, GA
  • NPI 1720117989
  NPD (past)

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359504000000",
    "number": "1457485682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 SOUTHCREST DR",
            "address_2": "SUITE 110",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816113",
            "telephone_number": "770-507-2212",
            "fax_number": "770-507-2213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 SOUTHCREST DR",
            "address_2": "SUITE 110",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302816113",
            "telephone_number": "770-507-2212",
            "fax_number": "770-507-2213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "SHEILA",
        "middle_name": "D",
        "credential": "RN, MNS,CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-16",
        "last_updated": "2013-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "21932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kizuwanda Blackburne, RPAC
• Demetrious J. Blackmon, M.D.
• Lee Blackwell Blackwell III, M.A.B.S
• Amanda Wall Blair, NNP-BC
• Donna Blair
• Christa Blakely
• Samira Bland, LPC
• Bloom and Restore Behavior and Education Service LP
• Rhonda Carolyn Bloschock, CRNA
• Penny Blount, PA-C

• All providers in Stockbridge, GA
• Pediatric Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2013; 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.