MEDICARE: DR. KELLY MARIE BLANKENSHIP DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	34008912	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396934162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY MARIE BLANKENSHIP DO

Provider Business Mailing Address
First Line	:	PO BOX 933421
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0039
Country	:	US
Telephone Number	:	937-641-5072
Fax Number	:	937-641-6129

Provider Business Practice Location Address
First Line	:	860 VALLEY ST.
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404
Country	:	US
Telephone Number	:	937-641-3060
Fax Number	:	937-641-3285

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	03/04/2026

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