Provider Demographics
NPI:1770357048
Name:BLAKE, BRIANNA TIPTON (PA)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:TIPTON
Last Name:BLAKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:MARIE
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 WALDEN RIDGE DR STE 30
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8598
Mailing Address - Country:US
Mailing Address - Phone:828-676-1657
Mailing Address - Fax:828-676-1658
Practice Address - Street 1:2 WALDEN RIDGE DR STE 30
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8598
Practice Address - Country:US
Practice Address - Phone:828-676-1657
Practice Address - Fax:828-676-1658
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-13762363A00000X, 363AM0700X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical