Provider Demographics
NPI:1407414568
Name:BLEDSOE, ALTHESIA
Entity type:Individual
Prefix:
First Name:ALTHESIA
Middle Name:
Last Name:BLEDSOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-5846
Mailing Address - Country:US
Mailing Address - Phone:319-457-5888
Mailing Address - Fax:
Practice Address - Street 1:6094 APPLE TREE DR STE 8
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-0306
Practice Address - Country:US
Practice Address - Phone:901-368-3339
Practice Address - Fax:901-368-3340
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1588299960Medicaid