Provider Demographics
NPI:1205995065
Name:BLANCHARD, KEVIN R (APRN, BC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:295 NEW BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5800
Mailing Address - Country:US
Mailing Address - Phone:508-675-6532
Mailing Address - Fax:
Practice Address - Street 1:295 NEW BOSTON RD
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5800
Practice Address - Country:US
Practice Address - Phone:508-674-9300
Practice Address - Fax:508-674-3126
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172084363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health