Provider Demographics
NPI:1972116457
Name:BLANKENSHIP, VICKIE MARIE
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:MARIE
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 1:1945 ACCOVILLE HOLLER
Mailing Address - Street 2:
Mailing Address - City:ACCOVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25606
Mailing Address - Country:US
Mailing Address - Phone:304-682-8235
Mailing Address - Fax:
Practice Address - Street 1:1945 ACCOVILLE HOLLER
Practice Address - Street 2:
Practice Address - City:ACCOVILLE
Practice Address - State:WV
Practice Address - Zip Code:25606
Practice Address - Country:US
Practice Address - Phone:304-682-8235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant