Healthcare Provider Details

I. General information

NPI: 1629329289
Provider Name (Legal Business Name): CARMIE SALINA BLANKENSHIP CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S. MAIN ST
SARDIS MS
38666
US

IV. Provider business mailing address

124 S. MAIN ST
SARDIS MS
38666
US

V. Phone/Fax

Practice location:
  • Phone: 662-487-1064
  • Fax: 662-487-1381
Mailing address:
  • Phone: 662-487-1064
  • Fax: 662-487-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR825148
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: