Provider Demographics
NPI:1003278722
Name:BLANKENSHIP, LANDON J (APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:LANDON
Middle Name:J
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 CRANBERRY DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-8560
Mailing Address - Country:US
Mailing Address - Phone:304-255-6404
Mailing Address - Fax:304-255-6494
Practice Address - Street 1:456 CRANBERRY DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-8560
Practice Address - Country:US
Practice Address - Phone:304-255-6404
Practice Address - Fax:304-255-6494
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN61531NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily