Provider Demographics
NPI:1023327814
Name:BLANEY, KRISTY M (RN, APRN)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:M
Last Name:BLANEY
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PHYSICIANS WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-8102
Mailing Address - Country:US
Mailing Address - Phone:615-444-3307
Mailing Address - Fax:
Practice Address - Street 1:100 PHYSICIANS WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8102
Practice Address - Country:US
Practice Address - Phone:615-444-3307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15335363L00000X
TN172789163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse