Provider Demographics
NPI:1538353057
Name:BLAKLEY, DAPHNE REENE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:DAPHNE
Middle Name:REENE
Last Name:BLAKLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:3 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-8913
Practice Address - Fax:573-884-1070
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2024-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004396363A00000X
MO2024033212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant