Provider Demographics
NPI:1356946909
Name:BLANKENSHIP, JACOB CODY
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:CODY
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 RIGHT FORK RD
Mailing Address - Street 2:
Mailing Address - City:MOHAWK
Mailing Address - State:WV
Mailing Address - Zip Code:24862-6400
Mailing Address - Country:US
Mailing Address - Phone:304-938-5012
Mailing Address - Fax:
Practice Address - Street 1:1499 RIGHT FORK RD
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:WV
Practice Address - Zip Code:24862-6400
Practice Address - Country:US
Practice Address - Phone:304-938-5012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant