Provider Demographics
NPI:1790393007
Name:BLANTON, KORI
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:BLANTON
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 1:3189 TIBURON WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8672
Mailing Address - Country:US
Mailing Address - Phone:596-934-9388
Mailing Address - Fax:
Practice Address - Street 1:1093 S BROADWAY STE 1218
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2677
Practice Address - Country:US
Practice Address - Phone:596-934-9388
Practice Address - Fax:606-886-4433
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health