Provider Demographics
NPI:1174023691
Name:BLANKENSHIP, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 EVANGELINE DR
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-2719
Mailing Address - Country:US
Mailing Address - Phone:409-769-0275
Mailing Address - Fax:
Practice Address - Street 1:615 EVANGELINE DR
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-2719
Practice Address - Country:US
Practice Address - Phone:409-769-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health