Healthcare Provider Details

I. General information

NPI: 1710636766
Provider Name (Legal Business Name): CHRISTAL A BLEVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 OLD ABBOTT MOUNTAIN RD
PRESTONSBURG KY
41653-1889
US

IV. Provider business mailing address

1709 KY ROUTE 321 STE 3
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-886-1260
  • Fax:
Mailing address:
  • Phone: 606-886-8546
  • Fax: 606-886-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1131476
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: