Provider Demographics
NPI:1245020718
Name:BLANKENSHIP, KAITLYN SHAE (RBT)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:SHAE
Last Name:BLANKENSHIP
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2429
Mailing Address - Country:US
Mailing Address - Phone:501-365-6547
Mailing Address - Fax:
Practice Address - Street 1:1106 W PINE ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2429
Practice Address - Country:US
Practice Address - Phone:501-365-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician