Doctor Name: | MR. BLAKE JOHN CARDEN |
NPI Number: | 1073983870 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 2025 N Mount Juliet Rd Ste 120 2025 North Mt. Juliet Road, Suite 120 Mount Juliet, TN - 371223935 |
Business Phone Number: | 6157732712 |
Business Fax Number: | 6157732707 |
Mailing Address: | 2025 N Mount Juliet Rd Ste 120, 2025 North Mt. Juliet Road, Suite 120 MOUNT JULIET |
State: | TN |
Postal Code: | 371223935 |
Phone Number: | 6157732712 |
Fax Number: | 6157732707 |
NPI Enumeration Date: | 10/06/2015 |
NPI Last Update Date: | 10/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |