Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | N/A | OK |
NPI | 1194041525 |
---|---|
Provider Name | Khrystal Blankenship |
First Address | Purcell, OK 73080-0662 |
Second Address | Ada, OK 74820-5828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 09/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100746700C | (05) | OK |