Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN61531NP | WV |
NPI | 1003278722 |
---|---|
Provider Name | Mr. Landon J Blankenship |
First Address | Beckley, WV 25801-8560 |
Second Address | Beckley, WV 25801-8560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 22/03/2016 |