Basic Information
| Provider Information | |||||||||
| NPI: | 1619201134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAKLEY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | HEJTMANCIK | ||||||||
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| Credential: | ACNS-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SHOAL CREEK BLVD | ||||||||
| Address2: | SUITE 205N | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787571098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122064341 | ||||||||
| FaxNumber: | 5124209043 | ||||||||
| Practice Location | |||||||||
| Address1: | 2559 WESTERN TRAILS BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787451554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124209900 | ||||||||
| FaxNumber: | 5124209043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2009 | ||||||||
| LastUpdateDate: | 12/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | 746798 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 2095259-01 | 05 | TX | MEDICAID |