Provider Demographics
NPI:1457950818
Name:BLANTON, KASSIDY SHEA (FNP)
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:SHEA
Last Name:BLANTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 KENDALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-9103
Mailing Address - Country:US
Mailing Address - Phone:704-214-3284
Mailing Address - Fax:
Practice Address - Street 1:113 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3803
Practice Address - Country:US
Practice Address - Phone:704-487-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBLAN-Q35QU207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine