Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

John A Blake, PA-C

Individual provider Physician Assistant · NPI 1780726570

John A Blake, PA-C is a Physician Assistant in Shallotte, North Carolina. Qualified in 2001, 25 years ago. Accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
25
Licensed in
NC
In the registry since
2007
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

712 Village Rd SW Ste 104
Shallotte, NC 28470-3449
Phone: (910) 754-7607
Fax: (910) 754-7608
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 103290NC (NC)

Record details

NPI number1780726570
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 12, 2007
Last updated in NPPESJune 3, 2019
Mailing address712 Village Rd Sw Ste 104, Shallotte, NC 28470-3449

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

Other providers in Shallotte