Individual
KRISTIN BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085004979
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263
TRICARE WEST
—
01
—
P00653958
RAILROAD MEDICARE
—
Enumeration date
08/31/2006
Last updated
11/17/2014
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