Tracey Nycole Blakley, FNP
Individual provider Active NPI Family Nurse Practitioner · Cumberland, KY
NPI 1497212302 · NPPES record last updated Aug 19, 2019
Key facts
- NPI
- 1497212302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 3012958 (KY)
- Practice address
- 1620 E Main St
Cumberland, KY 40823 - Phone
- (606) 589-6113
- Fax
- (606) 589-4436
- NPI assigned
- Feb 27, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 26
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mountain Comprehensive Health Corporation
Practice addresses (Care Compare)
1620 E Main St
Cumberland, KY 40823-1837
Phone (606) 589-6113
Hospital & facility affiliations
- Harlan Arh Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190911001870 | KY | Practitioner - Nurse Practitioner | 9638408982 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Comprehensive Health Corporation | Family | Current | Accepting new patients |
| Mountain Comprehensive Health Corporation | Family | Current |
Accepting new patients |
| Mountain Comprehensive Health Corporation | Current | Accepting new patients | |
| Mountain Comprehensive Health Corporation | Family | Current | Accepting new patients |
| Mountain Comprehensive Health Corporation | Current |
Accepting new patients | |
| Mountain Comprehensive Health Corporation | Current | Accepting new patients |
Locations
464 KY Highway 699
Cornettsville, KY 41731
Phone (606) 476-2450
1620 E Main St
Cumberland, KY 40823
Phone (606) 589-6113
1099 Highway 806
Eolia, KY 40826
Phone (606) 633-4654
132 Village Center Rd
Harlan, KY 40831
Phone (606) 573-2004
226 Medical Plaza Ln
Whitesburg, KY 41858
Phone (606) 633-4871
Interoperability endpoints
- tracey.blakley.p1@direct.mtncomp.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 3012958 | KY | Yes |
Addresses
Primary practice location
1620 E Main St
Cumberland, KY 40823
Mailing address
PO Box 40
Whitesburg, KY 41858-0040
Phone (606) 633-4823
Other practice location 1
28 Ellis road
Cumberland, KY 40823
Phone (606) 273-1234
Other providers in Cumberland, KY
- Christa Leigh Addington
- Appalachian Regional Healthcare, Inc
- Appalachian Regional Healthcare, Inc
- Appalachian Regional Healthcare, Inc.
- David Scott Berman
- Brittany Julene Boggs
- Melissa C Burns
- Allison Eulene Caudill
- John Chaney
- Destiny Clark
All providers in Cumberland, KY · Family Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.