Provider Demographics
NPI:1811518780
Name:BLANKENSHIP, SARA AMEND
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:AMEND
Last Name:BLANKENSHIP
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 1:1811 E BERT KOUN LOOP STE 400
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5764
Mailing Address - Country:US
Mailing Address - Phone:318-212-3810
Mailing Address - Fax:318-212-3815
Practice Address - Street 1:1811 E BERT KOUN LOOP STE 400
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5764
Practice Address - Country:US
Practice Address - Phone:318-212-3810
Practice Address - Fax:318-212-3815
Is Sole Proprietor?:No
Enumeration Date:2020-05-02
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN134042163W00000X
LA213810363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse