Michael Leeroy Blake

Primary specialty

Personal Care AttendantTaxonomy code 3747P1801X

Practice address

27 Boulder Rd
Glendale, WV 26038

Phone

(304) 650-1797

NPI assigned

Sep 7, 2022

Last updated

Sep 7, 2022By the provider in NPPES

Sex

Male

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1922729094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 BOULDER RD",
            "city": "GLENDALE",
            "state": "WV",
            "postal_code": "26038",
            "telephone_number": "304-650-1797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 BOULDER RD",
            "city": "GLENDALE",
            "state": "WV",
            "postal_code": "26038",
            "telephone_number": "304-650-1797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "MICHAEL",
        "middle_name": "LEEROY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125553494",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356607394",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821206228",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelly Behm, LPC
• Laura Brooke Bennington
• Justin Bier
• Mylena Bigford
• Kori Blake
• Natalie A Blowers, FNP-BC
• Jennifer Bonar, FNP-BC
• Dakota Benjamin Brooker, PA-C
• Yekaterina O Brown, DO
• Michael Warren Burkhart, M.D.

• Personal Care Attendant in Glen Dale, WV
• Providers in Glen Dale, WV by specialty
• Personal Care Attendant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.