Healthcare Provider Details

I. General information

NPI: 1003285776
Provider Name (Legal Business Name): BLANCHFILED ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8400
  • Fax: 270-798-8224
Mailing address:
  • Phone: 270-798-8400
  • Fax: 270-798-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberRN60187158
License Number StateWA

VIII. Authorized Official

Name: NICOLE RENEE DRAKE
Title or Position: CERTIFIED NURSE MIDWIFE
Credential: CNM, ARNP
Phone: 270-798-8400