Provider Demographics
NPI:1376600635
Name:BLAND, ANNIE RUTH (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:RUTH
Last Name:BLAND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:509 PASO FINO DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8662
Mailing Address - Country:US
Mailing Address - Phone:859-626-8614
Mailing Address - Fax:859-622-1972
Practice Address - Street 1:132 MINI MALL DRIVE
Practice Address - Street 2:BEREA HEALTH MINISTRY, INC.
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1170
Practice Address - Country:US
Practice Address - Phone:859-986-1274
Practice Address - Fax:859-986-1279
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4652P363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY183925Medicare ID - Type UnspecifiedCLINIC