Healthcare Provider Details

I. General information

NPI: 1144037672
Provider Name (Legal Business Name): BLESSING SHORT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 S 104TH AVE STE 100
PALOS PARK IL
60464-1508
US

IV. Provider business mailing address

5710 W ROOSEVELT ST
MONEE IL
60449-8014
US

V. Phone/Fax

Practice location:
  • Phone: 708-274-3278
  • Fax: 708-274-3299
Mailing address:
  • Phone: 815-662-7478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.010959
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: