Provider Demographics
NPI:1629500046
Name:BLANKENSHIP, JONATHAN DALE (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DALE
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2093
Mailing Address - Fax:423-390-3340
Practice Address - Street 1:240 MEDICAL PARK BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7352
Practice Address - Country:US
Practice Address - Phone:423-990-2400
Practice Address - Fax:423-990-2405
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine