MEDICARE: RENAE BLANTON A.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	706	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639107824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENAE BLANTON A.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 39368
Second Line	:
City	:	NINILCHIK
State	:	AK
Zip	:	99639-0368
Country	:	US
Telephone Number	:	907-567-3970
Fax Number	:	907-567-3902

Provider Business Practice Location Address
First Line	:	4047 BARTLETT ST
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-7566
Country	:	US
Telephone Number	:	907-206-2730
Fax Number	:	833-438-1910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	06/12/2025

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