MEDICARE: DR. LARRY NATHANIEL BLANKENSHIP AUD

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	231H00000X	Audiologist	23002915A	IN

General Provider Information

NPI Number	:	1427944743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY NATHANIEL BLANKENSHIP AUD

Provider Business Mailing Address
First Line	:	1401 E 360 N
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46012-9611
Country	:	US
Telephone Number	:	765-639-2956
Fax Number	:

Provider Business Practice Location Address
First Line	:	7926 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-4140
Country	:	US
Telephone Number	:	260-469-6919
Fax Number	:

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

Provider Enumeration Date	:	06/13/2025
Last Update Date	:	06/13/2025

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