Healthcare Provider Details

I. General information

NPI: 1437802980
Provider Name (Legal Business Name): HEATHER SHAW BLANKENSHIP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CHEMSTRAN AVE
DECATUR AL
35601-8900
US

IV. Provider business mailing address

1050 CHEMSTRAN AVE
DECATUR AL
35601-8900
US

V. Phone/Fax

Practice location:
  • Phone: 256-552-2522
  • Fax: 256-585-6426
Mailing address:
  • Phone: 256-552-2522
  • Fax: 256-585-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-135575
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number1-135575
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: