MEDICARE: JEFFERY BRADEN BLANKENSHIP M.D.

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	207Q00000X	Family Medicine Physician	48387	KY

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	:	1740627124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY BRADEN BLANKENSHIP M.D.

Provider Business Mailing Address
First Line	:	PO BOX 635283
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-5283
Country	:	US
Telephone Number	:	859-578-5662
Fax Number	:	859-261-3777

Provider Business Practice Location Address
First Line	:	200 W 3RD ST
Second Line	:
City	:	NEWPORT
State	:	KY
Zip	:	41071-1814
Country	:	US
Telephone Number	:	859-578-5662
Fax Number	:	859-261-3777

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

Provider Enumeration Date	:	05/27/2013
Last Update Date	:	07/12/2024

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