Provider Demographics
NPI:1740627124
Name:BLANKENSHIP, JEFFERY BRADEN (MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:BRADEN
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-578-5662
Mailing Address - Fax:859-261-3777
Practice Address - Street 1:200 W 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1814
Practice Address - Country:US
Practice Address - Phone:859-578-5662
Practice Address - Fax:859-261-3777
Is Sole Proprietor?:No
Enumeration Date:2013-05-27
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY48387207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0138104Medicaid
KYK159290Medicare PIN