Healthcare Provider Details

I. General information

NPI: 1609537562
Provider Name (Legal Business Name): CHRISTINA MARIE BLANKENSHIP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PATIENTS FIRST DR STE 2000
WASHINGTON MO
63090-4700
US

IV. Provider business mailing address

901 PATIENTS FIRST DR STE 2000
WASHINGTON MO
63090-4700
US

V. Phone/Fax

Practice location:
  • Phone: 636-390-1684
  • Fax: 636-231-3644
Mailing address:
  • Phone: 636-390-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2022000171
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2006019200
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: