Candler Kimsey Blake, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

1350 S. KNGS Dr
3Rd Floor
Charlotte, NC 28207

Phone

(704) 466-1242

Fax

(704) 446-1241

NPI assigned

Apr 26, 2023

Last updated

Jun 26, 2023By 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

Other names 1

• Candler Lorann Kimsey Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Interoperability endpoints

• Direct secure messaging: ckimsey945990@direct.unc.nchie.net

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

{
    "created_epoch": "1682467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687737600000",
    "number": "1679261796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 ZURICH PL",
            "city": "SAUTEE NACOOCHEE",
            "state": "GA",
            "postal_code": "305713508",
            "telephone_number": "706-969-2970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 S. KNGS DR",
            "address_2": "3RD FLOOR",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28207",
            "telephone_number": "704-466-1242",
            "fax_number": "704-446-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CANDLER",
        "middle_name": "KIMSEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CANDLER",
            "last_name": "KIMSEY",
            "middle_name": "LORANN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jemarian Chantinel Blair
• Judith Blaise
• Blake Home Health Care LLC
• Blake Resources LLC
• Bria Nikole Williams Blake, MD
• Charlene Blake
• Elana Blake, LCSWA
• Erin Blake, LMT
• Joshua Blake, DDS
• Kathryn Blake

• Student in an Organized Health Care Education/Training Program in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Student in an Organized Health Care Education/Training Program in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; 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.