Healthcare Provider Details

I. General information

NPI: 1790233187
Provider Name (Legal Business Name): LINDA KAY BLASINGAME APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 N WESTWOOD BLVD STE 5
POPLAR BLUFF MO
63901-2367
US

IV. Provider business mailing address

2725 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-2346
US

V. Phone/Fax

Practice location:
  • Phone: 573-872-4675
  • Fax: 573-872-4671
Mailing address:
  • Phone: 573-872-4675
  • Fax: 573-872-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR48867
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2021045824
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005080
License Number StateAR
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020012106
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: