Provider Demographics
NPI:1659322337
Name:BLANKENSHIP, ANDREA P (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:P
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2500
Mailing Address - Country:US
Mailing Address - Phone:606-432-5532
Mailing Address - Fax:606-432-5564
Practice Address - Street 1:1098 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1546
Practice Address - Country:US
Practice Address - Phone:606-432-5532
Practice Address - Fax:606-432-5564
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0000000327326OtherANTHEM OF KY
KY9500436200Medicaid
KY9500436200Medicaid
0552204Medicare ID - Type Unspecified