Provider Demographics
NPI:1457417230
Name:BLANKENSHIP, JENNIFER L (WHCNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8224 PARK LN STE 130
Practice Address - Street 2:VICKERY HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6021
Practice Address - Country:US
Practice Address - Phone:214-266-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643191363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145299705Medicaid
TX145299709Medicaid
TX145299702Medicaid
TX145299704Medicaid
TX145299701Medicaid
TX145299711Medicaid
TX145299703Medicaid
TX145299708Medicaid
TX8Y1540OtherBLUE CROSS BLUE SHIELD
TX145299706Medicaid
TX145299707Medicaid
TX145299710Medicaid