NPIMap

Individual provider Active NPI

Kimberly Lorene Blake, FNP-C

  • Family Nurse Practitioner
  • Conway, AR
National Provider Identifier
1689971749
Registry record updated May 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A03482 ANP Issued in AR
Practice address
1125 Skyline Dr
Conway, AR 72032-6657
Phone
(501) 358-6120
Fax
(501) 358-6268
NPI assigned
Feb 24, 2011
Last updated
May 10, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A03482 ANP AR Primary

Addresses

Primary practice location

1125 Skyline Dr
Conway, AR 72032-6657

Mailing address

1125 Skyline Dr
Conway, AR 72032-2857
Phone (501) 358-6120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111111000667 AR Practitioner - Nurse Practitioner 0941474738 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faulkner Emergency Group, PLLCGroup PAC ID 1557694049, 19 clinicians

Practice addresses (Care Compare)

2302 College Ave
Conway, AR 72034-6297
Phone (501) 329-3831

827 Faulkner St
Conway, AR 72034-5224
Phone (501) 382-1977

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A03482 ANPARMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Conway Regional Medical Center Inc CurrentSince Aug 1, 2017 Accepting new patients
Wound Logix LLC CurrentSince Aug 1, 2025 Accepting new patients
Faulkner Emergency Group, PLLC CurrentSince May 22, 2019 Accepting new patients
Golden Sparrow Health, PLLC CurrentSince Aug 1, 2025 Accepting new patients
Ozark Health, Inc Current Accepting new patients
Conway Regional Medical Center Inc CurrentSince Aug 1, 2017 Accepting new patients
Ozark Health, Inc CurrentSince Oct 15, 2011 Accepting new patients
Elite Medical Group LLC CurrentSince Nov 1, 2024 Accepting new patients
Springdale- Bentonville HBP Services, LLC CurrentSince Feb 21, 2025 Accepting new patients

Locations

3000 Medical Center Pkwy
Bentonville, AR 72712
Phone (479) 553-2524

2526 Highway 65 S
Ste 201
Clinton, AR 72031
Phone (501) 745-3388

2302 College Ave
Conway, AR 72034
Phone (501) 329-3831

383 Dave Creek Pkwy
Fairfield Bay, AR 72088
Phone (501) 745-3388

120 W Race Ave
Ste 9
Searcy, AR 72143
Phone (501) 290-2400

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494374400000",
    "number": "1689971749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 SKYLINE DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720322857",
            "telephone_number": "501-358-6120",
            "fax_number": "501-358-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 SKYLINE DR",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720326657",
            "telephone_number": "501-358-6120",
            "fax_number": "501-358-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "KIMBERLY",
        "middle_name": "LORENE",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-24",
        "last_updated": "2017-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A03482 ANP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

Verify at the official NPI Registry.