Provider Demographics
NPI:1851744437
Name:BLANKENSHIP, SHAWN ROBERT (APRN FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:ROBERT
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1948
Mailing Address - Country:US
Mailing Address - Phone:681-265-1693
Mailing Address - Fax:681-265-0990
Practice Address - Street 1:4815 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1948
Practice Address - Country:US
Practice Address - Phone:681-265-1693
Practice Address - Fax:681-265-0990
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN82678-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily