Provider Demographics
NPI:1538618178
Name:BLAKE, LEEANN MCCAMY (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LEEANN
Middle Name:MCCAMY
Last Name:BLAKE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4837
Mailing Address - Country:US
Mailing Address - Phone:704-774-1255
Mailing Address - Fax:704-774-1226
Practice Address - Street 1:102 E WINDSOR ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4837
Practice Address - Country:US
Practice Address - Phone:704-774-1255
Practice Address - Fax:704-774-1226
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008953363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner