MEDICARE: JEANNIE BLANKENSHIP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver	OH
2	372500000X	Chore Provider	OH
3	374U00000X	Home Health Aide
4	171M00000X	Case Manager/Care Coordinator	OH

General Provider Information

NPI Number	:	1740018431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNIE BLANKENSHIP

Provider Business Mailing Address
First Line	:	2184 CHENOWETH FORK RD
Second Line	:
City	:	PIKETON
State	:	OH
Zip	:	45661-9568
Country	:	US
Telephone Number	:	740-648-0088
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 SUNFISH CREEK RD
Second Line	:
City	:	PIKETON
State	:	OH
Zip	:	45661-9781
Country	:	US
Telephone Number	:	740-648-0088
Fax Number	:

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

Provider Enumeration Date	:	07/24/2024
Last Update Date	:	07/24/2024

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Directions to “ JEANNIE BLANKENSHIP ” Practice Location

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