Provider Demographics
NPI:1811590839
Name:BLANKENSHIP, BOBBIE JEAN
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JEAN
Last Name:BLANKENSHIP
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 1:66 CARDINAL COURT LOT 20
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WV
Mailing Address - Zip Code:25033
Mailing Address - Country:US
Mailing Address - Phone:304-395-4955
Mailing Address - Fax:
Practice Address - Street 1:66 CARDINAL COURT LOT 20
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WV
Practice Address - Zip Code:25033
Practice Address - Country:US
Practice Address - Phone:304-395-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant