Provider Demographics
NPI:1205386018
Name:BLUDNICK, KERRY WILLIAM MICHAEL (CNP)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:WILLIAM MICHAEL
Last Name:BLUDNICK
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22952 BOLENDER PONTIUS RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9040
Mailing Address - Country:US
Mailing Address - Phone:740-252-8994
Mailing Address - Fax:
Practice Address - Street 1:22952 BOLENDER PONTIUS RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9040
Practice Address - Country:US
Practice Address - Phone:740-252-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 376J00000X
OHAPRN.CNP.019474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker