Tara Nicole Blake

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

37492 Issued in WV

Practice address

3633 Seneca TRL S
Peterstown, WV 24963-5063

Phone

(304) 994-1490

NPI assigned

Dec 17, 2025

Last updated

Dec 17, 2025By 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

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": "1765929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1487519898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 SENECA TRL S",
            "city": "PETERSTOWN",
            "state": "WV",
            "postal_code": "249635063",
            "telephone_number": "304-994-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 SENECA TRL S",
            "city": "PETERSTOWN",
            "state": "WV",
            "postal_code": "249635063",
            "telephone_number": "304-994-1490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "TARA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-17",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WV",
            "license": "37492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Lynn Bogenschutz
• Kandi Jo Boggs
• Kimberly Bowman
• Camc Greenbrier Valley Medical Center, Inc. (CAMC Greenbrier Valley Medical Center Primary Care)
• Jayne Ladier Canterbury, D.O.

• Licensed Practical Nurse in Peterstown, WV
• Providers in Peterstown, WV by specialty
• Licensed Practical Nurse in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; 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.