Basic Information
Provider Information
NPI: 1003000282
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLAKEMORE
FirstName: ROSIE
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: TENNESSEE PRISON FOR WOMEN
Address2: 3881 STEWARTS LANE
City: NASHVILLE
State: TN
PostalCode: 372430001
CountryCode: US
TelephoneNumber: 6157411255
FaxNumber: 6157262181
Practice Location
Address1: TENNESSEE PRISON FOR WOMEN
Address2: 3881 STEWARTS LANE
City: NASHVILLE
State: TN
PostalCode: 372430001
CountryCode: US
TelephoneNumber: 6157411255
FaxNumber: 6157262181
Other Information
ProviderEnumerationDate: 08/30/2007
LastUpdateDate: 08/30/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPN0000005086TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home