Kelley E Blake, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1-150592 Issued in AL

Practice address

3332 W Main St Ste 2
Dothan, AL 36305-1019

Phone

(334) 246-2577

Fax

(949) 561-5764

NPI assigned

Nov 11, 2008

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 identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Bandw Medical Solutions LLCGroup PAC ID 5294121935, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kelleyb@bwmedicalsolutions.kareodirect.com

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

• B&W Medical Solutions LLC

  • Family Medicine Physician
  • Dothan, AL
  • NPI 1427710896
  Medicare reassignment Care Compare group NPD Authorized official
• Wiregrass Clinic LLC

  • Neurological Surgery Physician
  • Dothan, AL
  • NPI 1558657890

  Family

  Medicare reassignment NPD

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1770737249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3332 W MAIN ST STE 2",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051019",
            "telephone_number": "334-246-2577",
            "fax_number": "949-561-5764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3332 W MAIN ST STE 2",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051019",
            "telephone_number": "334-246-2577",
            "fax_number": "949-561-5764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "KELLEY",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-11",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1-150592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181693",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kelleyb@bwmedicalsolutions.kareodirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "PDF",
            "address_1": "3332 W Main St Ste 2",
            "city": "Dothan",
            "state": "AL",
            "country_code": "US",
            "postal_code": "363051019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Black-Hardwick, MS, LPC
• Anthony Shane Black, DC
• Jawaunna Talon Blackmon, M.D.
• Keith A. Blackmon, D.D.S.
• Ryan Douglas Blackwell
• Blakes Enrichment Services LLC
• Rose Blakey, LPC
• Angela S Blaxton, M.D.
• Ryan Yvette Bletcher
• Alena Cherry Blissett, LPC

• Family Nurse Practitioner in Dothan, AL
• Providers in Dothan, AL by specialty
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.