Provider Demographics
NPI:1649356619
Name:BLANCHARD, KERRY A (PA-C)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7008 CUT PLAINS TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-2376
Mailing Address - Country:US
Mailing Address - Phone:908-303-2143
Mailing Address - Fax:
Practice Address - Street 1:12717 SHOPS PKWY STE 500
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6623
Practice Address - Country:US
Practice Address - Phone:512-222-8667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010032363AM0700X, 363AM0700X
TXPA15461363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical