Provider Demographics
NPI:1992159909
Name:BLANKENSHIP, KAITLIN C (MD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:C
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1790 N STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7437
Mailing Address - Country:US
Mailing Address - Phone:972-390-9002
Mailing Address - Fax:214-491-3777
Practice Address - Street 1:2548 LILLIAN MILLER PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7212
Practice Address - Country:US
Practice Address - Phone:940-387-7565
Practice Address - Fax:940-566-0574
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXS9463207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS9463OtherTEXAS MEDICAL BOARD