NPI 1013994953 · live from the CMS NPI Registry
John Vayden Blake, PA
Physician Assistant in Summersville, WV. National Provider Identifier 1013994953, active.
NPI record
| NPI | 1013994953 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 315 Fairview Heights Rd, Summersville, WV 26651 |
| Practice phone | 304-469-2905 |
| Mailing address | 497 Mall Rd, Oak Hill, WV 25901 |
| Enumerated | December 30, 2005 |
| Last updated | January 3, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 202 (WV) |
| Physician Assistant primary | 363A00000X | 929 (WV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.