Provider Demographics
NPI:1528008547
Name:BLANKENSHIP, WALTER DAVID (PA)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:DAVID
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 LARK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5929
Mailing Address - Country:US
Mailing Address - Phone:865-776-0800
Mailing Address - Fax:
Practice Address - Street 1:9135 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1425
Practice Address - Country:US
Practice Address - Phone:865-558-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMB1192183363A00000X
TN1171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00232697OtherRAILROAD MEDICARE
TN4099853OtherBLUE CROSS
TNP00232697OtherRAILROAD MEDICARE