Healthcare Provider Details

I. General information

NPI: 1205995065
Provider Name (Legal Business Name): KEVIN R BLANCHARD APRN, BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 NEW BOSTON RD
FALL RIVER MA
02720-5800
US

IV. Provider business mailing address

295 NEW BOSTON RD
FALL RIVER MA
02720-5800
US

V. Phone/Fax

Practice location:
  • Phone: 508-674-9300
  • Fax: 508-674-3126
Mailing address:
  • Phone: 508-675-6532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number172084
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: