Provider Demographics
NPI:1710636766
Name:BLEVINS, CHRISTAL A
Entity Type:Individual
Prefix:
First Name:CHRISTAL
Middle Name:A
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N MAYO TRL
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1811
Mailing Address - Country:US
Mailing Address - Phone:606-789-3188
Mailing Address - Fax:606-789-3190
Practice Address - Street 1:520 N MAYO TRL
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1811
Practice Address - Country:US
Practice Address - Phone:606-789-3188
Practice Address - Fax:606-789-3190
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1131476363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily