Healthcare Provider Details

I. General information

NPI: 1356358477
Provider Name (Legal Business Name): MARY LOUISE BLANKENSHIP RN, FNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 SW 68TH PKWY STE 200
TIGARD OR
97223-9058
US

IV. Provider business mailing address

1907 NW 6TH ST
HERMISTON OR
97838-1148
US

V. Phone/Fax

Practice location:
  • Phone: 971-352-6971
  • Fax:
Mailing address:
  • Phone: 972-825-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10006006
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023150476
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0375722
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: