Provider Demographics
NPI:1356305262
Name:BLANKENSHIP, BARBARA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANN
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W TIETAN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4498
Mailing Address - Country:US
Mailing Address - Phone:509-525-3720
Mailing Address - Fax:509-522-1593
Practice Address - Street 1:55 W TIETAN ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4445
Practice Address - Country:US
Practice Address - Phone:509-525-3720
Practice Address - Fax:509-525-3720
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID123012085R0202X
WAMD000377222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8256976Medicaid
WA171827OtherL&I
WA1008358Medicaid
ID1356305262Medicaid
WA324988OtherLNI PROVIDER ID
WA324984OtherLNI PROVIDER ID
WA324986OtherLNI PROVIDER ID
WAGAB37848Medicare PIN
WAP01290951Medicare PIN
WA324986OtherLNI PROVIDER ID
WAG8923849Medicare PIN
WA1008358Medicaid
WAG8925868Medicare PIN
WA171827OtherL&I
WA8256976Medicaid