Provider Demographics
NPI:1487435202
Name:BLAKELY, TEMEKIA SHAUNTRICE
Entity type:Individual
Prefix:
First Name:TEMEKIA
Middle Name:SHAUNTRICE
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11653 COUNTY ROAD 7
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-7157
Mailing Address - Country:US
Mailing Address - Phone:334-300-2819
Mailing Address - Fax:
Practice Address - Street 1:11653 COUNTY ROAD 7
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-7157
Practice Address - Country:US
Practice Address - Phone:334-300-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-1414215163W00000X
ALAG0223047363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology