Healthcare Provider Details

I. General information

NPI: 1235844838
Provider Name (Legal Business Name): DEANA ALICIA BLANTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 MILLS AVE
GREENVILLE SC
29605-4019
US

IV. Provider business mailing address

203 MILLS AVE
GREENVILLE SC
29605-4019
US

V. Phone/Fax

Practice location:
  • Phone: 864-271-1844
  • Fax: 864-271-2147
Mailing address:
  • Phone: 864-271-1844
  • Fax: 864-271-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209816
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number27117
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: