Provider Demographics
NPI:1174893846
Name:BLAKEY, JESSICA LYNETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNETTE
Last Name:BLAKEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LYNETTE
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9731 N KITCHEN RD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-6537
Mailing Address - Country:US
Mailing Address - Phone:317-370-5971
Mailing Address - Fax:
Practice Address - Street 1:9731 N KITCHEN RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-6537
Practice Address - Country:US
Practice Address - Phone:317-370-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28144480A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse