Provider Demographics
NPI:1386878957
Name:BLANKENSHIP, HOLLY SPURLOCK (DO)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:SPURLOCK
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:370 DOOLITTLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1129
Mailing Address - Country:US
Mailing Address - Phone:615-603-7445
Mailing Address - Fax:615-603-7447
Practice Address - Street 1:370 DOOLITTLE RD STE 1
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1129
Practice Address - Country:US
Practice Address - Phone:615-603-7445
Practice Address - Fax:615-603-7447
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2360207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0131089146Medicare UPIN