PENNY BLAKE (APRN) – Family Nurse Practitioner, NPI 1215489935
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
22,204 NURSE PRACTITIONER in TX
Provider Addresses for PENNY BLAKE (APRN)
1600 US HIGHWAY 79 S
HENDERSON, TX 756544508
Phone: (903) 717-3260
Type: Location
1107 E Marshall Ave
Longview, TX 756015602
Phone: (903) 758-2610
Fax: (903) 758-7081
Type: Location
703 E Marshall Ave Ste 4008
Longview, TX 756015622
Phone: (903) 315-2729
Type: Location
PO BOX 1022
WAYNESBORO, TN 384851022
Phone: (931) 722-2369
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-01-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170119000245 | I | Nurse Practitioner | TX | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 75654)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| General Surgery | AZ | |
| Internal Medicine | TX | |
| Nurse Practitioner | TX | |
| Nurse Practitioner | TX | |
| - | TX | |
| E N D O C R I N O L O G Y | TX | |
| Nurse Practitioner | IL | |
| - | NC | |
| Physician Assistant | LA | |
| Hospitalist, Gastroenterology | TX |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.