Provider Demographics
NPI:1043272404
Name:BLANKENSHIP, MARY B (CFNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1578
Mailing Address - Country:US
Mailing Address - Phone:740-532-4858
Mailing Address - Fax:740-532-4859
Practice Address - Street 1:13804 STATE ROUTE 141
Practice Address - Street 2:
Practice Address - City:KITTS HILL
Practice Address - State:OH
Practice Address - Zip Code:45645-8848
Practice Address - Country:US
Practice Address - Phone:740-643-2082
Practice Address - Fax:740-643-2126
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06557363LF0000X
OH022224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2274828Medicaid
WV7101172000Medicaid
KY78011251Medicaid
WV7101172000Medicaid
OH2274828Medicaid