Jessica Carole Blake, FNP
Individual provider Active NPI Nurse Practitioner · Newberry, SC
NPI 1760154447 · NPPES record last updated Jan 7, 2025
Key facts
- NPI
- 1760154447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 25430 (SC)
- Practice address
- 1410 Wilson Rd
Newberry, SC 29108-3050 - Phone
- (803) 276-2186
- Fax
- (803) 276-2630
- NPI assigned
- Oct 1, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Novant Health Urgent Cares LLC
Practice addresses (Care Compare)
1410 Wilson Rd
Newberry, SC 29108-3050
Phone (803) 276-2186
Hospital & facility affiliations
- Newberry County Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- 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 |
|---|---|---|---|---|
| I20220114001507 | SC | Practitioner - Nurse Practitioner | 8022400415 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25430 | SC | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medcare Urgent Care Center - Anderson LLC | Current |
Accepting new patients | |
| McLeod Regional Medical Center of the Pee Dee, Inc | Current |
Accepting new patients | |
| Medcare Express - North Charleston LLC | Current |
Accepting new patients | |
| Novant Health Urgent Cares LLC | Current |
Accepting new patients | |
| Lexington Health Inc | Current |
Accepting new patients | |
| Lexington Health Inc | Current | Accepting new patients | |
| Three Rivers Medical Associates, PA | Family | Current |
Accepting new patients |
| McLeod Regional Medical Center of the Pee Dee, Inc | Current |
Accepting new patients | |
| Lexington Health Inc | Current |
Accepting new patients | |
| Three Rivers Medical Associates, PA | Family | Current | Accepting new patients |
| Three Rivers Medical Associates, PA | Current |
Accepting new patients |
Locations
6167 Braided Mane Pass SW
Aiken, SC 29803
Phone (803) 502-1484
1301 Taylor St
Ste 5K
Columbia, SC 29201
Phone (803) 765-2090
555 E Cheves St
Florence, SC 29506
Phone (843) 662-5233
7430 College St
Irmo, SC 29063
Phone (803) 732-4001
811 W Main St
Ste 101
Lexington, SC 29072
Phone (803) 936-7230
1410 Wilson Rd
Newberry, SC 29108
Phone (803) 276-2186
8720 Dorchester Rd
North Charleston, SC 29420
Phone (843) 552-3629
2720 Sunset Blvd
West Columbia, SC 29169
Phone (803) 791-2480
Interoperability endpoints
- https://api.platform.athenahealth.com/25140/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 25430 | SC | |
| Family Nurse Practitioner | 363LF0000X | 25430 | SC | |
| Nurse Practitioner | 363L00000X | 25430 | SC | Yes |
Addresses
Primary practice location
1410 Wilson Rd
Newberry, SC 29108-3050
Mailing address
PO Box 749306
Atlanta, GA 30374-9306
Other practice location 1
2720 Sunset Blvd
West Columbia, SC 29169-4810
Phone (803) 936-7372
Other practice location 2
7430 College St
Irmo, SC 29063-2903
Phone (839) 200-7810
Other practice location 3
555 E Cheves St
Florence, SC 29506-2617
Phone (843) 777-2000
Other practice location 4
1330 Dutch Fork Rd
Irmo, SC 29063-8825
Phone (803) 749-1666
Other providers in Newberry, SC
- Shannon Beckham Berley
- Michael Jerome Bernardo
- Katherine Bills
- Bio-Medical Applications of South Carolina, Inc.
- Rebecca Susan Biscoglia
- Jeffrey Bodenhamer
- Elizabeth Bozard
- Thomas F Bradberry
- Branch & Stafford Optometric Associates, PA
- Sarah H Brickley
All providers in Newberry, SC · Nurse Practitioner in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 7, 2025. 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.