MEDICARE: KIMBERLY IRENE BLANTON

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	3747P1801X	Personal Care Attendant		WV

General Provider Information

NPI Number	:	1659204089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY IRENE BLANTON

Provider Business Mailing Address
First Line	:	106 SAND MINE RD
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-7457
Country	:	US
Telephone Number	:	304-258-3096
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 SAND MINE RD
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-7457
Country	:	US
Telephone Number	:	304-258-3096
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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