Healthcare Provider Details

I. General information

NPI: 1710488390
Provider Name (Legal Business Name): KATI BLANKENSHIP CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 05/30/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 TOWNSHIP RD 1257
CHESAPEAKE OH
45619
US

IV. Provider business mailing address

7938 ESTER CT
ASHLAND KY
41102-9728
US

V. Phone/Fax

Practice location:
  • Phone: 740-451-0307
  • Fax: 740-451-0311
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: